The Pandemic’s Devastating Toll on America’s Nursing Homes

Nearly one year after the first confirmed coronavirus case on U.S. soil, we have passed 400,000 COVID-19 deaths. And, according to the latest data, this tragic figure includes over 153,000 residents and staff in nursing homes and long-term care facilities. That’s more than one-third of all COVID-19 deaths in the U.S., even though nursing home residents make up just 1% of the population.  

AARP’s analysis in the AARP Nursing Home COVID-19 Dashboard indicates that leading up to the emergency use authorization of the first vaccine in mid-December, the COVID-19 crisis in America’s nursing homes was getting worse, not better. Cases and deaths nearly quadrupled from the four weeks ending September 20 through the four weeks ending December 20 – an unconscionable statistic. As long as the pandemic is raging out in the community, COVID-19 is knocking on the door of nearly every nursing home across the country. In the four weeks ending December 20, 87 percent of nursing homes had a least one confirmed staff case, and 59 percent had at least one confirmed resident case. Since the beginning of 2020, 90 percent of America’s nursing homes have had a resident with COVID-19.

There is tremendous hope that the distribution of vaccines will turn the tide and make a real difference protecting the health and lives of these vulnerable seniors and the hard-working people who care for them.  Federal guidelines put nursing home residents and staff at the top of the list along with front-line healthcare workers, and a dedicated program using two national drug store chains to vaccinate this population and other long-term care facility residents and staff kicked off in December. 

What started with great fanfare, however, has had more than a few hiccups, and there are ongoing challenges. News stories highlight issues including insufficient staffing and extra time needed to track down family members designated to sign consent forms. And, there have been numerous reports that a significant percentage of nursing home staff are declining the vaccine in this first wave – their skepticism fueled by distrust of a system where they have been underpaid, underappreciated, and, in many cases, overlooked when it came to distributing PPE and other support during the pandemic.  

Fortunately, the pace of vaccinations in these facilities appears to be picking up, with some states launching their own efforts to get it done efficiently. I fear, though, that we will see one or two more months of lives being lost before things start getting better.

While vaccinations continue, nursing homes and other long-term care facilities must continue to have necessary personal protective equipment, testing, adequate staffing, and strong infection control measures to help control the spread of the virus and save lives. And, every effort must be made to help residents safely stay connected with their loved ones through virtual visits and other means. 

This also can’t be the end of efforts to improve health and safety in nursing homes and other long-term care facilities. The brutal toll of COVID-19 is shining a spotlight on problems that predate the pandemic. Last year, the U.S. Government Accountability Office reported that 82 percent of all nursing homes were cited at least once for an infection control deficiency between 2013 and 2017.

Policymakers must act with a sense of urgency on both short and long-term reforms.  We need to end the horrific impact of COVID-19 in America’s nursing homes AND ensure that they are safe places for current and future residents. That could mean increased staffing levels with better pay, training and benefits; more oversight; and penalties for failure to take appropriate precautions. (This AARP Bulletin article has 10 ideas for reform). I guarantee that millions of older Americans and their families are paying attention and rethinking their long-term care plans. Everything should be on the table. This is quite literally a matter of life and death.