Nursing Homes Experienced Steeper Increase In COVID-19 Cases and Deaths in August 2021 Than the Rest of the Country

Staff and residents at long-term care facilities were particularly hard-hit by the first year of the pandemic, accounting for 31% of all COVID-19 deaths in the US as of June 30, 2021.  KFF analysis found that, following vaccine rollout in winter 2020-2021, weekly cases and deaths in long-term care facilities (including nursing homes, assisted living facilities, ICF/IIDs, and other settings) dropped, reaching an all-time low in June 2021, just prior to the rapid increase in national cases and deaths due to the Delta variant. As Delta spread across the US in the summer of 2021, much of the focus was on young children at risk during back-to-school; however, with the Delta surge, older Americans, especially those 85 and older, continued to face higher risk of death due to COVID-19 compared to younger Americans, according to the CDC. This data note analyzes federal nursing home data to determine the ongoing impact of the pandemic on COVID-19 cases and deaths among staff and residents. See methods box for more details.

Nursing homes across the US reported nearly 1,800 COVID-19 deaths among residents and staff in August 2021, the highest number of COVID-19 deaths reported in a single month since February 2021 and a steady increase from the approximately 350 deaths reported in July 2021 (Figure 1). This jump in the total number of deaths due to COVID-19 reverses the sustained pattern of decreasing deaths since CMS implemented the Pharmacy Partnership For Long-Term Care, even though the number of nursing home deaths due to COVID-19 in August 2021 was still far below the peak of over 22,000 seen in December 2020 (Table 1).

Deaths attributable to COVID-19 increased at a faster rate in nursing homes than among all others in the community between July and August 2021. The number of COVID-19 deaths among staff and residents in nursing homes quadrupled between July and August, while COVID-19 deaths in the community doubled in the same time period (Table 1). During this period, deaths increased at a faster rate among nursing home residents than among nursing home staff (423% versus 274%). While the vast majority of COVID-19 deaths happened outside of nursing homes in July and August, the high rate of increase within nursing homes indicates that residents and staff in these settings are at risk of death during the Delta surge, and not immune from the most recent wave.

COVID-19 cases also increased more rapidly in nursing homes than in the community. Nursing home cases grew by 440% (from 9,000 to 48,800) between July and August 2021, with a slightly higher increase in resident cases (483%, growing from 3,200 to 19,000) than staff cases (416%, growing from 5,700 to 29,600). Cases outside of nursing homes increased by 224% in the same time period, growing from 1.3 million to 4.2 million (Table 1).  Similar to COVID-19 deaths, the vast majority of COVID-19 cases occurred outside of nursing homes. However, the high rate of increase of nursing home cases shows the connection between community spread and the spread of the virus in nursing homes.

While recent news coverage has focused heavily on the impact of the pandemic on children and unvaccinated adults, the pandemic continues to disproportionately impact older adults and people with disabilities. The CDC recently endorsed an extra dose of the COVID-19 vaccine for a number of additional populations, including residents of long-term care settings, which would make booster shots available to people who live in nursing homes. In addition, the Biden administration has recently announced staff vaccination mandate for nursing homes. As of mid-September 2021, about 84% of all nursing home residents and 64% of all nursing home staff are vaccinated. Vaccines coupled with boosters may reverse the recent trend of rising cases and deaths within nursing homes, though ongoing spread in the community continues to have an impact on residents and staff.

This analysis uses federal data on coronavirus cases and deaths in nursing homes, which includes weekly data as of mid-May 2020 through August 29th, 2021. Data has been rolled up to the month level, with each month of data representing between 4 and 5 weeks of data. This analysis excludes suspected cases from the definition of nursing home cases among residents and staff. Data on community cases and deaths are calculated based on the number of nationwide cases and deaths from the Johns Hopkins Coronavirus Resource Center minus nursing home cases and deaths; we make this adjustment to account for possible endogeneity (that is, cases or deaths in nursing homes contributing to the patterns in COVID-19 cases and deaths nationwide). The federal data includes only data on federally certified nursing homes. This analysis therefore does not include data on other long-term care settings, such as assisted living facilities, residential care facilities, group homes, or intermediate care facilities.

Previous analysis used state-reported data on long-term care facility cases and deaths, which represented a more comprehensive set of facilities. Due to a drop-off in reporting regularity and lack of consistency in states overtime, this analysis uses federal data to be able to trend cases and deaths in nursing homes since June 2020.

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