COVID-19 taking devastating toll on nursing homes, federal report says

Nearly 26,000 residents died and 60,000 were infected as the coronavirus swept through U.S. nursing homes in recent months, particularly affecting facilities with a history of low marks for staffing and patient care, the federal government reported Monday.

The number of deaths represent nearly a quarter of the 104,450 deaths reported in the United States as of Monday.

The virus also infected 34,000 staff and took the lives of more than 400, according to the Centers for Medicare and Medicaid Services, the federal agency that oversees the nation’s nursing homes.

The numbers represent the first official national accounting of fatalities in the 15,000 nursing homes that receive Medicare and Medicaid funding. The tally, however, is incomplete. About 80% of the nation’s nursing homes reported data to the federal government, and they were required only to include cases since early May. The federal data does not include assisted living facilities, which some states count in their coronavirus nursing home totals.

CMS officials nevertheless said they were confident that the figures offer a reliable snapshot of the pandemic in the nation’s hard-hit nursing homes.

“This represents a good picture of where we’ve been,” CMS Administrator Seema Verma said in a call with reporters Monday afternoon.

A Washington Post accounting of cases and deaths in nursing homes shows a higher toll, and that tally rounds up data from less than half of the states. Based on reports from 21 states since the beginning of the pandemic, The Post found that more than 28,000 residents have died.

The Indiana State Department of Health on Monday said 945 deaths—or 47.8% of the state’s total—involved long-term care patients. The state said 150 facilities have experienced at least one COVID-19 death.

Nationally, of the homes that reported data to CMS, 1 in 5 recorded at least one death from COVID-19, the disease caused by the coronavirus, and 1 in 4 had at least one positive case. In the District of Columbia and three states—New Jersey, Connecticut and Massachusetts—more than 1 in 10 nursing home residents died, according to the data collected so far by CMS.

An early analysis by CMS showed that nursing homes that have received poor marks for nurse staffing and patient care were more likely to see higher case counts than those with stronger track records.

Statistical analyses touted by the industry, by contrast, suggest that the outbreaks have little to do with the quality of nursing homes. Instead, studies indicate that a home’s location and size are better predictors of an outbreak.

“Significant research from leading health experts, including analysis from Harvard medical school and Brown University as well as testimony to Congress by the University of Chicago, has shown no correlation between COVID-19 outbreak and [Medicare’s] star rating system,” said Beth Martino, American Health Care Association senior vice president of public affairs, referring to the government’s quality grades for nursing homes. “In fact, the first COVID case was at a five-star rated facility. As this research shows, the amount of COVID-19 cases in nursing homes has been directly linked to the level of the virus in the surrounding local community.”

On Monday, Verma focused heavily on infection control, saying the agency would strengthen enforcement, including civil penalties, of nursing homes with persistent violations of federal standards meant to prevent the spread of illness. The move, according to CMS, would “help prevent backsliding, improve accountability and ensure prompt compliance.”

Nursing homes across the country have struggled with infection control both before and during the pandemic. In April, a Post analysis of about 650 homes with cases of the coronavirus found that 40% had been cited more than once for infection control deficiencies in recent years.

Verma said the agency will distribute $80 million to states to increase infection-control inspections of nursing homes during the pandemic. States that fail to inspect all Medicare-certified homes by July 31 will be required to submit a corrective plan to the federal government. Those still lagging by August will lose some of the money.

The new federal data, while limited, comes after months of criticism from watchdog groups and patients’ families, who argued that transparency is critical during a public health emergency. Since the first known outbreak at a nursing home, in Washington state in February, some states have repeatedly declined to name affected facilities or describe the scale of the problem, forcing families to plead for information from homes that were often reluctant to release details.

“I think people have a right to know what’s going on—and not all this hiding,” said Toby Edelman, a senior policy attorney at the nonprofit Center for Medicare Advocacy. “If the nursing homes would just tell the truth, people would respect them a lot more than this language about ‘We love our residents.'”

In April, CMS announced that all nursing homes would be required to report case information to the Centers for Disease Control and Prevention on a weekly basis. CMS requested data by May 17 but gave nursing homes a two-week grace period to report.

Mark Parkinson, president of the American Health Care Association and National Center for Assisted Living, said the newly reported numbers validate the need for widespread testing and more support for nursing homes.

“Especially as we continue to expand testing for residents and staff in long term care centers in June, we should anticipate the number of cases to rise as asymptomatic residents and staff will be identified,” he said. “While an increase in these reported numbers may be startling, it will improve our ability to confront this threat and protect our residents.”

The data released on Monday did not include case or death counts for individual facilities. Those numbers are expected to be released on Thursday.