Almost 40% of COVID-19 deaths nationwide are concentrated in nursing homes and assisted living facilities, at least in the states reporting the data, a non-profit foundation’s analysis found.
The data was compiled by The Foundation for Research on Equal Opportunity, which defines itself as a “non-profit think tank focused on expanding economic opportunity to those who least have it.” The organization found that 26,778 of the 67,533 U.S. COVID-19 deaths – or nearly 40 percent – in its study period occurred in such facilities. Minnesota led the nation with 81.7% of its COVID-19 deaths in such facilities. Outside of New York State, the percentage rises to an estimated 51%, the foundation reported on May 7, 2020 (its spreadsheet contains data from May 4-10).
Heavy spoke to two experts on the issue; you can read their comments later in the story. “We need a shared community approach to this. We are all in this together,” said Dr. Bruce Troen, chief of the Division of Geriatrics and Palliative Medicine at the University at Buffalo. His research is focused on geriatric medicine, aging, and care for older patients.
Both experts stressed the need for better testing. “If we get better testing that’s more reliable…hopefully we can prevent anybody with a chance of being COVID positive from working in a nursing home until they’re over it,” said Dr. Alice Bonner, PhD, RN. She is director of Strategic Partnerships for CAPABLE and Adjunct Faculty at Johns Hopkins University School of Nursing and a senior advisor in Aging, IHI.
One study in Colorado found that nursing home employees who have COVID-19 with no symptoms were coming to work and sickening elderly residents. The Coloradoan reported that 12.3% of the 462 employees testing positive in a Colorado State University Project study didn’t report any symptoms.
On May 11, The New York Times reported that COVID-19 deaths in such facilities accounted for 35% of the country’s total, although 11% of the nationwide positive infections occurred at them. This follows along the lines of research showing that elderly patients, especially those with pre-existing conditions, don’t beat back COVID-19 as easily.
The Times’ numbers included employees as well as residents. A Washington Post study in late April found that one of six such facilities nationwide reported COVID-19 infections. The numbers can vary somewhat depending on the time period studied, but they have a common thread: COVID-19 is hitting the nation’s nursing homes and assisted living centers very hard.
Some policy choices may have influenced the trend. For example, The Wall Street Journal reported that New York in May reversed a policy mandating that nursing homes accept COVID-19 positive patients discharged from hospitals. In one such nursing home, Gurwin Jewish Nursing and Rehabilitation Center, at least 24 COVID-19 deaths resulted after the center started housing people with COVID-19, NBC News reports. Some have criticized New York’s incomplete reporting of nursing home deaths.
A March 25 memo from the New York Department of Health stated, “all NHs (nursing homes) must comply with the expedited receipt of residents returning from hospitals to NHs. No resident shall be denied re-admission or admission to the NH solely based on a confirmed or suspected diagnosis of COVID-19. NHs are prohibited from requiring a hospitalized resident who is determined medically stable to be tested for COVID-19prior to admission or readmission.”
One research study found large percentages of COVID-19 deaths in nursing homes and assisted living centers in some other countries as well.
A Heavy review of nursing home COVID-19 stories in multiple U.S. states found repeated concerns about non-transparency with names or data and slow testing.
Gregg Girvan and Avik Roy did the data collection for Freoop.org. In an article on the foundation’s website, Girvan called it the “most underappreciated aspect of the novel coronavirus pandemic.” Their research looked at state-by-state data on COVID-19. The facilities included centers like traditional nursing homes, hospices, and adult day service centers. The article said the foundation measured “those living in nursing homes and assisted living facilities.” Some states have higher rates of nursing home use:
The federal government has said it will start releasing data on COVID-19 in nursing homes after concerns in multiple states that the information wasn’t being disclosed. CNN reported that nursing home workers around the country warned the government about safety violations in at least 500 complaints.
According to Freoop, data wasn’t available for Alaska, Hawaii, Kansas, Michigan, Missouri, New Mexico, North Dakota, South Dakota, Utah, Vermont, and Wyoming.
“At least half of older adults living in long-term care facilities suffer from cognitive impairment with Alzheimer’s disease or other dementias,” the Centers for Disease Control and Prevention noted. “Memory care services, designed to meet the unique needs of residents with dementia, are often provided in dedicated care units or wings of a facility. Infection prevention strategies to prevent the spread of COVID-19 are especially challenging to implement in dedicated memory care units.”
Here’s what you need to know:
What the Experts Say
Heavy spoke to experts who study aging or nursing home issues.
In an interview, Dr. Troen told Heavy that almost “wherever you look in the country, there are a disproportionate amount” of COVID-19 deaths occurring in nursing homes or assisted living facilities. He said that fact should provoke a conversation about “how we really value older adults in this country,” pointing out that 1.3 million people in the United States are in skilled nursing facilities and about 800,000 plus are in assisted living facilities.
Even before COVID, nursing homes were “a ripe environment for infections,” and there was an estimated 1 to 3 million serious infections in these facilities, Troen said. People had infections for things like skin, urinary tract and respiratory ailments.
He said that such facilities also have high turnover and many people closer to end of life. He said there was a push to pull back and reduce some regulations for nursing homes under the Trump administration before COVID.
He said that nursing homes are places where older adults are quite vulnerable because they have medical conditions and often cognitive impairment. Thus, they have “increased difficulty in cooperating with infection control measures.” Nursing homes also struggle to meet staffing guidelines. People live close together and engage in group activities. “You take all of that and toss COVID-19 into this mix” and you have a big problem, he said.
Troen said that COVID is more infectious than the seasonal flu and people are “infectious before symptoms occur.” He said nursing homes are a “perfect cauldron… for not only (having people) contract the illness but suffering very dire circumstances. It is a perfect storm, I guess you could say.”
He said that some nursing homes did act very quickly and were able to reduce infections. There needs to be more resources, staffing and surveillance, he said. He said COVID’s symptoms run a “broader scope” than seasonal flu. It’s respiratory, but the symptoms aren’t confined.
According to Troen, society has a “shared responsibility to think about our vulnerable.”
When people go out into society without social distancing, such as at taverns, the problem is they might get very ill themselves but they also might bring it back to more vulnerable family members. He noted COVID’s “long incubation times. The lag time is significant.” He said more frequent testing is needed. “It’s really testing, testing, testing. This is going to be with us for months.”
He noted that the virus was “brought into them,” referring to the facilities.
Troen also stressed the need for a vaccine and said COVID has a “silent incubation period.” How nursing homes are financed and the kinds of resources they have can play into locality differences in numbers, he said.
In an interview with Heavy, Bonner said that there’s a lot still unknown about the virus, including exactly why so many deaths nationally have occurred in nursing homes and assisted living centers. However, she said they are in environments “that are congregate environments” where staff and residents interact closely with one another.
“A lot of staff members are asymptomatic for many days when carrying the virus,” she said. By the time they realize they have it or have symptoms, they’ve “already been in close contact with lots of people.”
Nursing homes are also environments where as many as half of the residents can suffer cognitive impairment making some unable to follow requirements like social distancing or wearing masks. Such facilities are “close quarters” where people eat and do activities very close together so “they’re spreading the virus in an environment hard to control,” Bonner said.
She said the virus is unpredictable and “we don’t understand it very well,” but it does appear to affect people with underlying conditions, making them higher risk. COVID-19 has affected high and low-performing nursing homes at the same rate, she said. “It doesn’t know how many stars you have.”
What’s the solution?
She said that people are working on a vaccine and medication that mitigates the effects. She stressed the need for more reliable, faster testing.
She noted that these are environments with limited staff and limited training of staff. They are environments with “more complexity.”
Bonner said it’s important that such facilities separate the COVID positive from the negative, but some are small facilities. She said the “death rates are much higher” with COVID-19 than seasonal flu.
“It feels significantly different from the flu, and we don’t have a vaccine,” she said. She said it’s important to have more “pragmatic trials out in the field to figure out which of these things actually mitigate the spread” and mitigate hospitalizations. She thought there needed to be more communication in instances when nursing homes are faced with accepting COVID-19 patients discharged from hospitals.
Below you can see each state with data available. The percentage represents the percentage of COVID-19 deaths in nursing homes and assisted living centers, according to Freeop.org. We’ve also provided links to government statistics on COVID-19 deaths and cases for each state and, in multiple cases, other information about their battles against COVID-19 in such facilities. (You can see the New York Times’ numbers, which are slightly different, here.)
The deaths in Alabama included two dozen people who died at an Alabama veterans nursing home.
The Alabama Nursing Homes Association issued a news release on the issue as early as April 6, saying, “Alabama nursing homes continue to do everything they can to prevent the spread of COVID-19 and treat those who are diagnosed with the virus.” The news release delays in testing.
See government data on Alabama and COVID-19 here.
The Alabama state government data says 699 long-term care facility employees and 1,099 residents had contracted coronavirus as of May 14, 2020. Only 4.6% of people who died of COVID-19 in Alabama did not have underlying conditions. More than 80% were over age 65.
Advocates in Arizona criticized a lack of testing in the facilities, but the governor was promising to ramp it up. Maricopa County has an advice page on COVID-19 directed to long-term care facilities.
See state data on COVID-19 for Arizona here.
The state reported that 37 positive cases of COVID-19 were linked to one nursing home in Ash Flat. That number included staff and residents; cases were reported in 51 nursing homes in Arkansas as of May 14.
See the state’s coronavirus data here.
According to the San Francisco Chronicle, 14 residents of a Stanislaus County skilled nursing facility died of COVID-19 and nearly 150 residents and staff members tested positive.
See California’s state data here.
In Colorado, dozens of nursing homes were cited for not following COVID-19 safety protocols, according to KDVR-TV.
See Colorado’s state coronavirus data here.
The government has released a listing of COVID-19 nursing home cases by nursing home name. See it here.
See D.C.’s coronavirus page here.
See Delaware’s coronavirus page here. “Among those facing the highest risk for COVID-19 are individuals living in long-term care facilities (LTC). DHSS’ Division of Health Care Quality is working closely with facilities to verify that they have strong screening, infection and isolation measures in place,” the state of Delaware says.
As of May 13, Florida was reporting that 776 nursing home residents and staff have died of COVID-19, according to The Palm Beach Post.
On May 13, Macon.com reported that “Georgia long-term care facilities have a total of 4,210 residents who have tested positive for the coronavirus, 1,862 staff members who have tested positive and 672 resident deaths.”
See the coronavirus page for Hawaii here.
As of April 12, there had been no Hawaiian care facility COVID-19 cases, something attributed to extreme measures like banning guests.
Some employees told the Idaho Statesman they were being asked to report to work without proper equipment even after people tested positive.
The state was promising to ramp up testing.
See the Indiana coronavirus database here. 13News compiled a database on COVID-19 cases in long-term care facilities after families expressed concern they couldn’t get enough information out of the state.
According to TriState, as of May 14, “87 residents in 89 facilities in Kentucky have died from the virus, along with two employees who have died.”
“It’s a group of people with either advanced age or advanced medical conditions who are living in relatively close quarters with people, with caregivers who are going from patient to patient,” Jefferson Parish Coroner Dr. Gerry Cvitanovich told the television station. The news organization has had trouble getting full information from governmental officials.
See the state’s coronavirus page here.
In late April, News Center Maine reported that more than half of the state’s COVID-19 deaths were in nursing homes.
Coronavirus outbreaks were reported at group homes for people with disabilities.
As of May 14, the state was reporting 2,209 staff cases, 11 staff deaths, 5,329 resident cases and 984 resident deaths.
According to a May 13 article in The Baltimore Sun, such deaths accounted for 59% of the total and rose 25% that week.
See the coronavirus page for Massachusetts here.
On May 12, the Boston Herald reported that “Of the 5,141 virus deaths in Massachusetts, 3,095 have occurred in the state’s nursing homes.”
“With respect to nursing homes, Massachusetts has unfortunately evolved into a national hotspot for coronavirus,” Gov. Charlie Baker said in an April news conference. “Nursing facilities have been hard hit by this insidious virus. It’s particularly tough and lethal for older adults.”
See Michigan’s coronavirus data page here.
The state has released data and names of long-term care facilities, which you can find here.
Bridge.com reported that some families are upset by what they see as spotty reporting of COVID-19 cases in long-term care facilities in Michigan.
See the data for Minnesota and coronavirus here. The state gives this data:
Deaths among cases that resided in long-term care or assisted living facilities: 554
Probable COVID-19 Deaths: 9
See the Minnesota guidance page regarding COVID-19 here. According to the Center Square, “One in five nursing homes have cases, less than one in 10 assisted living facilities have cases, and most facilities with cases have one or two.”
See the Mississippi coronavirus page here. On April 28, the Clarion Ledger reported that “Ninety-one Mississippi nursing homes and similar long-term care centers have reported at least one coronavirus case” but said government officials weren’t being transparent in giving much information about them.
See the Missouri coronavirus page here.
St. Louis Public Radio reported May 3 that “hundreds of nursing homes have reported outbreaks, including Frontier Health and Rehabilitation in St. Charles, where at least 64 residents have tested positive and 17 have died” but authorities were facing criticism for failure to release names.
The May 14 article reported that deaths from such facilities now accounted for 70% of the state’s deaths.
The state now has a tracker for such cases and reported on May 14 that 69 residents and two staff members had died.
See the state’s coronavirus page here.
See New Jersey’s coronavirus page here.
See New Mexico’s coronavirus page here.
See New York’s coronavirus page here.
Access the North Carolina coronavirus data page here.
North Dakota’s coronavirus page can be accessed here.
Find Ohio’s coronavirus portal here.
See the Oklahoma coronavirus page here.
The data for Pennsylvania and coronavirus can be accessed here.
See Rhode Island’s COVID-19 page here.
Find South Carolina’s COVID-19 updates here.
See the South Dakota coronavirus page here.
Tennessee’s coronavirus page is here.
See the State of Texas coronavirus web page here.
Utah’s coronavirus update page is here.
The Vermont coronavirus page can be found here.
The Virginia coronavirus page can be found here.
See the Washington State resource page for COVID-19 here.
See the West Virginia coronavirus page here.
“As we continue to see cases of COVID-19 in nursing homes, it is important to be transparent and list the locations where they are occurring,” said DHS Secretary-designee Andrea Palm. “We have opted to publish the names of nursing homes in order to provide peace of mind to families who cannot visit or check on their loved ones during these unprecedented times. We are grateful for all the important work that nursing homes are doing to prevent spread and the proactive steps they have taken to facilitate communication among families, loved ones and the residents in their care.”
You can find the full list on the bottom right of the state’s website.
See Wyoming’s COVID-19 page here.