Nursing Homes Hit Hard by COVID-19 Pandemic - Are You Worried About Residents’ Safety?

Due to their residents’ advanced ages and high concentration of preexisting medical conditions that raise their COVID-19 risk, nursing homes have become hotspots for COVID-19 cases. 

• Nationally, the Centers for Disease Control and Prevention (CDC) reports that 2.1 million people (0.6% of the U.S. population) live in nursing homes or residential care facilities. Yet, nursing home and residential care facilities account for 42% of all COVID-19 deaths, based on data from states that represent such statistics.
• As of mid-May, 35% of COVID-19 deaths and 11% of COVID-19 cases in the U.S. were in long-term care facilities.

According to analysis by The Foundation for Research on Equal Opportunity (FREOPP) using data up to May 12, the share of COVID-19 deaths occurring in nursing homes and assisted living facilities varies widely between states. 

• New Hampshire, where 72.2% of COVID-19 deaths were in such facilities, has the largest share of COVID-19 deaths in nursing homes and assisted living facilities.
• New York, with 12.7% of COVID-19 deaths occurring in nursing homes and assisted living facilities, has the lowest share of COVID-19 deaths in such facilities.

Given this information, it's worth asking: how are nursing homes keeping residents safe during the pandemic?

Testing staff, enforcing social distancing, and limiting visitors

Testing and social distancing are the key measures that nursing homes are using to control COVID-19’s spread. 

• The Nursing Facility Accountability and Support Program, which offered $130 million for nursing homes, required nursing homes to test at least 90% of their residents and staff for COVID-19 between April 8 and May 25 in order to qualify for funds.
• On a May 11 phone call with state governors, Vice President Mike Pence and Dr. Deborah Birx, White House coordinator for the virus response, recommended that every nursing home resident and staff member in the U.S. be tested for COVID-19 by May 25 (this recommendation was not taken up by the states).
• In Washington state, Gov. Jay Inslee has announced a plan to test all nursing home residents and staff members for COVID-19 by June 12, with positive results reported immediately to the state. Similar testing plans have been announced in California, New York, New Jersey, Florida, and Texas (however, these plans’ implementations are complicated by testing kit shortages and questions around funding).

The Centers for Medicare & Medicaid Services (CMS) and Centers for Disease Control and Prevention (CDC) have issued guidance aimed at reducing COVID-19’s spread in nursing homes. The recommendations include:

• Strictly limiting visitation;
• Suspending communal dining and group activities for residents;
• Screening residents daily for fevers and other COVID-19 symptoms;
• Screening anyone entering facilities for symptoms
• Observing flexible sick-leave policies for staff members; and
• Requiring staff to wear masks

If COVID-19 is detected in a nursing home, the federal agencies recommend:

• Restricting residents to their rooms;
• Requiring health care staff to wear gowns, gloves, eye protection, and N95 masks; and
• Treating suspected and confirmed COVID-19 cases in a designed area separate from other residents.

Disproportionate fatalities in nursing homes

Despite nursing homes’ precautions, COVID-19 cases and deaths are disportionately found in these facilities.

• The North Carolina Dept. of Health and Human Services reports that 421 out of 794 deaths in the state — more than half of all the state’s deaths — were of nursing home residents. Additionally, as of Wednesday, May 27, 3,041 of the state’s 24,629 positive COVID-19 cases were also in nursing homes.
• 44% of Illinois’ COVID-19 deaths have been among long-term care facility residents — in total, 2,402 long-term care facility residents have died. Additionally, there have been 14,882 confirmed COVID-19 cases in long-term care facilities.
• In Michigan, 23% of the state’s COVID-19 deaths have been residents of nursing homes. As of Tuesday, May 26, 1,216 nursing home residents had died. Additionally, nursing homes in the state have had at least 4,920 confirmed COVID-19 cases, accounting for 9% of the state’s total caseload. State officials warn that these preliminary counts undercount nursing home deaths and cases, as 13% of facilities haven’t reported COVID-19 information to the state.
• In New York, 6,035 nursing home and adult care facility residents have died. Advocates say that the current figure still doesn’t represent the true casualty count, as the state initially only counted residents who tested positive for COVID-19 and died at the facility (it has since added residents with suspected cases) and is still not including adult care facility residents who were transferred to a hospital and died in the hospital.

Use of nursing homes for COVID-19 patients

In early May, it was revealed that a number of states — New York, California, New Jersey, Massachusetts, and Michigan — were sending some COVID-19 patients back to nursing homes to recuperate. In New York state, a state guideline at the time said that nursing homes could not refuse to take patients from hospitals solely because they have COVID-19. 

In fact, in April, New York issued a rule requiring nursing homes to readmit residents sent to hospitals with COVID-19, and to accept new patients as long as they were “medically stable.” California and New Jersey issued similar policies.

Public outcry over these states’ policies has caused some policy reversals.

• In mid-May, New York Gov. Andrew Cuomo reversed his order requiring nursing homes in New York to accept COVID-19 patients.
• Massachusetts, which originally issued a directive similar to New York’s, dialed its order back after criticism.
• California reversed its policy requiring nursing homes to take COVID-19 patients after an outcry from patient advocates.

However, in Michigan, Gov. Gretchen Whitmer extended her state’s order requiring nursing homes to take COVID-19 patients in mid-May.

As of now, California and Massachusetts have designated certain nursing home & long-term care facilities for COVID-19 patients alone. This is considered the safest way to free up hospital beds. Robin Dale, president of the Washington Health Care Association, which represents long-term care facilities in Washington State, is an advocate for the adoption of such a policy in her state. She says:

“[The adoption of a policy designating COVID-19-only facilities has] got to happen. Then we would not have this hodgepodge of every nursing home in the state having one or two positives and crossing your fingers that it works out.”

Find nursing homes with COVID-19 cases and deaths

Are you concerned about your own or a loved one’s long-term care facility? The New York Times is compiling a list of cases and deaths at long-term care facilities that have at least 50 cases.

Share your thoughts

Sound off in the comments: do you think nursing homes are doing enough to protect residents against COVID-19? If you think current efforts to keep nursing home residents aren’t enough, what you like to see nursing homes do instead?

—Lorelei Yang

(Image Credit: iStockphoto.com / filadendron)