The independent Coronavirus Commission for Safety and Quality in Nursing Homes – which was tasked with assessing the response to the COVID-19 pandemic in nursing homes and made recommendations for additional actions CMS could take – reported recently that U . S . nursing home residents and staff represent only 8 percent of COVID-19 cases yet bear 41 percent of COVID-19 deaths based on data reported August 13 .
A look at the medical literature also provides some sense of the magnitude of the morbidity and mortality associated with the COVID-19 pandemic in the LTC sector . In their review , Salcher-Konrad , et al . ( 2020 ) identified 54 study reports ; outbreak investigations in LTC facilities found COVID-19 incidence rates of between 0.0 percent and 71.7 percent among residents and between 0.4 percent and 64.0 percent among staff at affected facilities . Mortality rates varied from 0.0 percent to 17.1 percent of all residents at outbreak facilities , with case fatality rates between 0.0 percent and 33.7 percent . In included studies of outbreaks , no LTC staff members had died . Studies of wider LTC populations found that between 0.4 percent and 40.8 percent of residents , and between 4.0 percent and 23.8 percent of staff were infected , although the generalizability of these studies is limited .
GAO analysis of Centers for Disease Control and Prevention ( CDC ) data shows that winter 2020 was marked by a significant surge in the number of COVID-19 cases and deaths for nursing home residents and staff . Specifically , during mid-December 2020 , there were more than 33,600 new resident cases and 28,600 new staff cases , which was more than twice as high as the prior case number peaks in summer 2020 . According to a GAO report ( 2021a ), CDC data showed that cases and deaths in nursing homes are on the decline . Specifically , as of the week ending Feb . 7 , 2021 , resident and staff cases have both declined by more than 80 percent since their peaks in December 2020 . The changing weekly COVID-19 death counts in nursing homes generally moved in the same direction as changes in the country . With the introduction of vaccines , observers are hopeful that nursing homes may be beginning to see a reprieve ; however , the emergence of more highly transmissible virus variants warrants the need for continued vigilance , according to public health officials .
GAO analysis of data from the CDC shows that , from May 2020 through January 2021 , nursing homes commonly experienced multiple COVID-19 outbreaks . According to CDC , an outbreak starts the week a nursing home reports a new resident or staff COVID-19 case and ends when there are two weeks with no new cases . GAO ( 2021b ) found that nursing homes had an average of about three outbreaks during the review period , with most of the nursing homes ( 94 percent , or 12,555 of the 13,380
Comparing Nursing Homes and Assisted- Living Facilities
A lthough assisted-living settings obviously differ from nursing homes in terms of the overriding model of care ( such as the social versus medical model ) and staffing ( meaning lower staffing levels and less nursing care ), it is interesting to look at illness and death rates from COVID-19 . In assisted-living facilities , Thomas , et al . ( 2021 ) report that national all-cause mortality rates were significantly higher in 2020 compared with 2019 ( an average of 2.30 versus 2.02 deaths per 1,000 residents per week ; 17 percent higher overall mortality ). During the peak week of April 8-14 , 2020 , assisted living resident mortality was 3.28 deaths per 1,000 residents per week compared with 2.24 deaths per 1,000 residents during the same week in 2019 . New York had the greatest excess mortality between 2020 and 2019 ( an average of 2.50 versus 1.57 deaths per 1,000 residents per week during January to August ) followed by New Jersey ( 2020 versus 2019 , 3.03 vs 2.09 deaths per 1,000 residents per week ). Among the 10 states with the highest community spread during this period , excess mortality was 2.39 deaths per 1,000 residents per week in 2020 during January to August versus 1.93 deaths per 1,000 residents per week during January to August in 2019 . nursing homes ) experiencing more than one COVID-19 outbreak .
For each nursing home ’ s longest-lasting COVID-19 outbreak , GAO ( 2021b ) found that about 85 percent ( 11,311 nursing homes ) had outbreaks lasting five or more weeks . Conversely , for about 15 percent of nursing homes ( 2,005 homes ), the longest outbreak was shorter in duration , lasting between one and four weeks , with 267 of those homes able to control their outbreaks after the initial week .
GAO ( 2021b ) notes that its previous reports documented the numerous challenges nursing homes have faced in battling COVID-19 , and adds , “ While challenges related to staffing shortages have persisted through the pandemic , challenges related to obtaining PPE and conducting COVID-19 tests — although still notable — have generally shown signs of improvement since summer 2020 . Further , with the decline in nursing home cases , CMS updated its guidance in March 2021 to expand resident visitation , an issue that has been an ongoing and persistent challenge during the pandemic . Some new challenges have also emerged as vaccinations started for nursing home residents and staff . Some of these challenges , such as staffing shortages , obtaining PPE , and conducting testing , are critically important for infection control .” Let us look at each issue .
Visitation
Through interviews with researchers , advocacy organizations , and national association officials from July 2020 to February 2021 , GAO ( 2021b ) reports that it consistently heard that “ nursing homes have faced an ongoing tension between providing residents with important visitation and minimizing the potential for a COVID-19 outbreak .” Specifically , the restriction of visitors has negatively affected residents ’ mental and physical health . Researchers and advocacy organizations have noted that the isolation resulting from decreased visitation can cause loneliness , anxiety and depression among residents . Additionally , the restriction of visitors has created limited oversight of facilities through the exclusion of resident advocates , such as family members and ombudsmen .
Staffing
In reviews of CDC data and interviews with advocacy organization and national association officials from July 2020 through January 2021 , GAO ( 2021b ) “ consistently found that nursing home staffing challenges were difficult and ongoing throughout the pandemic .” For example , CDC data from July through December 2020 consistently show that about 1 in 5 nursing homes were reporting that they had a shortage of nurse aides or other support staff . From nursing home associations that it interviewed , GAO heard that many alternative staffing sources have been used to fill critical gaps , such as seeking help from
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