Data Note: How might Coronavirus Affect Residents in Nursing Facilities?

Introduction

While knowledge about COVID-19 continues to evolve daily, experts agree that certain populations are particularly vulnerable to severe cases of the infection – those with chronic conditions, compromised immune systems, and of old age. Nursing facilities provide care to populations with those characteristics, and residents in these facilities are particularly at risk of developing serious illness or dying if infected. In 2017, there were approximately 1.3 million residents receiving care across 15,483 nursing facilities in the US (Table 1). This data note provides key data points to highlight the potential implications of COVID-19 on nursing facility residents and overall operations.

Share of nursing home residents receiving respiratory treatment

Many residents in nursing facilities have underlying respiratory issues and may be at particular risk of illness should they contract coronavirus. One common symptom of coronaviruses is respiratory illness. About 16 percent of all residents in nursing facilities across the US received respiratory treatment in 2017, which includes using respirators/ventilators, oxygen, inhalation therapy, and other treatment. Given the implications of this virus on respiratory systems, these residents could be at higher risk of severe outcomes if they were to become infected. In states such as Colorado and Utah, over 30% of residents in nursing facilities are receiving respiratory treatment (Table 1). Ventilator supply is also crucial to consider, given the increased demand for this equipment for those severely impacted by COVID-19.

Share of nursing home residents with depression

Anxiety and depression are also common among nursing facility residents, and these health problems may be exacerbated by fear, worry, or social isolation due to COVID-19. Residents in nursing facilities are at risk of being diagnosed with psychiatric disorders, with nearly 40% having experienced symptoms of depression (Table 1). In Washington, where media attention has been centered on the outbreak of coronavirus in nursing facilities, almost half of residents have experienced depression or depressive symptoms. Research on family involvement in long-term care has shown that family visitation can have potentially positive effects on cognitive and behavioral health diagnoses.1 Thus, visitor restrictions in nursing facilities, which are currently being implemented to lower the risk of exposure among residents who would be vulnerable to illness if infected, may also have negative impacts on residents’ mental health and increase the incidence of depressive symptoms.2

Share of nursing homes with deficiencies in infection control

Deficiencies related to the spread of infectious disease are relatively common in nursing facilities, with nearly 40% of facilities having at least one infection control deficiency in 2017 (Table 1). Deficiencies related to infection control are the most common deficiency that nursing facilities report, followed by food sanitation (36%) and accident environment (34%). In Delaware, Mississippi, Missouri, Illinois, Michigan, and California, over half of facilities reported at least one deficiency related to infection control (Table 1 and Figure 1). Given the importance of following infection control procedures in mitigating the spread of the virus, facilities that have historically reported infection control deficiencies could be at elevated risk of a COVID-19 outbreak.

Figure 1: States with high shares of nursing homes with deficiencies related to spread of infection

Occupancy rates in nursing homes

Resident density could have an impact on how fast an outbreak of COVID-19 might spread in a particular facility. Nationally, four of every five nursing facility beds were filled in 2017, with some states such as New York and DC reporting even higher occupancy density (over 90%) (Table 1). Higher occupant density puts residents at risk of quicker spread.

In the early stages of the COVID-19 epidemic in the U.S., residents in nursing facilities have been affected more than any other group and account for a large share of deaths. These residents’ physical and mental health conditions, facilities’ abilities to deal with infectious disease, and occupancy rates are all important considerations when thinking about addressing the spread of COVID-19 in nursing homes and other vulnerable populations.

Table 1: COVID-19 Related Nursing Home Data Indicators
State Total number of nursing facilities Total number of nursing facility residents Share of residents in facilities receiving respiratory treatment Share of residents in facilities with depression Share of facilities with deficiencies related to infectious disease control Facility occupancy rate
Alabama 228 22,482 18% 31% 48% 84%
Alaska 18 608 12% 35% 33% 88%
Arizona 145 11,343 23% 31% 22% 70%
Arkansas 231 17,439 18% 32% 39% 71%
California 1198 101,030 16% 23% 63% 85%
Colorado 221 16,078 32% 45% 42% 78%
Connecticut 223 22,653 16% 34% 31% 85%
Delaware 45 4,181 15% 32% 51% 87%
Dist. of Columbia 18 2,380 14% 24% 39% 92%
Florida 690 72,741 17% 32% 42% 87%
Georgia 359 33,043 14% 41% 19% 83%
Hawaii 42 3,474 10% 24% 43% 85%
Idaho 71 3,319 28% 49% 49% 63%
Illinois 731 66,643 14% 52% 56% 74%
Indiana 552 38,682 15% 41% 35% 73%
Iowa 437 23,638 15% 46% 22% 77%
Kansas 276 14,657 18% 47% 34% 77%
Kentucky 285 22,760 20% 36% 37% 85%
Louisiana 277 26,169 12% 26% 29% 77%
Maine 100 5,947 13% 49% 15% 87%
Maryland 226 24,414 14% 37% 40% 87%
Massachusetts 399 38,673 11% 38% 30% 84%
Michigan 443 38,062 16% 34% 58% 81%
Minnesota 375 24,755 15% 46% 40% 86%
Mississippi 204 15,950 12% 27% 51% 88%
Missouri 518 37,874 16% 38% 52% 70%
Montana 72 4,153 20% 43% 42% 65%
Nebraska 214 11,394 18% 50% 31% 72%
Nevada 61 5,336 27% 29% 38% 76%
New Hampshire 74 6,442 15% 41% 26% 87%
New Jersey 364 44,033 16% 25% 31% 84%
New Mexico 74 5,693 24% 39% 36% 79%
New York 609 101,518 14% 38% 20% 90%
North Carolina 429 35,763 16% 33% 17% 81%
North Dakota 80 5,531 15% 51% 34% 91%
Ohio 966 73,826 17% 52% 28% 82%
Oklahoma 303 18,361 18% 42% 30% 64%
Oregon 136 7,317 17% 32% 33% 65%
Pennsylvania 693 76,652 18% 36% 46% 87%
Rhode Island 83 7,817 9% 44% 5% 90%
South Carolina 191 16,993 14% 31% 21% 86%
South Dakota 108 5,984 18% 54% 43% 90%
Tennessee 314 26,481 19% 35% 31% 73%
Texas 1,227 92,250 12% 37% 48% 69%
Utah 99 5,178 32% 48% 43% 63%
Vermont 36 2,440 14% 49% 14% 79%
Virginia 286 27,595 18% 35% 38% 86%
Washington 217 15,993 17% 46% 43% 77%
West Virginia 123 9,251 18% 40% 42% 87%
Wisconsin 374 24,239 15% 45% 38% 77%
Wyoming 38 2,428 29% 47% 47% 82%
US TOTAL 15,483 1,321,663 16% 37% 39% 80%
SOURCES: KFF analysis of 2017 OSCAR/CASPER nursing facility data
Endnotes
  1. Gaugler, Joseph E. "Family involvement in residential long-term care: A synthesis and critical review." Aging & mental health 9.2 (2005): 105-118.

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  2. Vernon L. Greene, PhD, Deborah J. Monahan, MA, The Impact of Visitation on Patient Well-Being in Nursing Homes, The Gerontologist, Volume 22, Issue 4, August 1982, Pages 418–423

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