43% Of COVID-19 Deaths Are In Nursing Homes & Assisted Living Facilities Housing 0.6% Of U.S.

By Avik Roy. Excerpts:

"Americans are vigorously debating the merits of continuing to lock down the U.S. economy to prevent the spread of COVID-19. A single statistic may hold the key to resolving this debate: the astounding share of deaths occurring in nursing homes and assisted living facilities.

Nursing homes and assisted living facilities: The #1 COVID problem

2.1 million Americans, representing 0.62% of the U.S. population, reside in nursing homes and assisted living facilities. (Nursing homes are residences for seniors needing help with activities of daily living, such as taking a shower or getting dressed, who also require 24/7 medical supervision; assisted living facilities are designed for seniors who need help with activities of daily living, but don’t require full-time on-site medical supervision.)

According to an analysis that Gregg Girvan and I conducted for the Foundation for Research on Equal Opportunity, as of May 22, in the 39 states that currently report such figures, an astounding 43% of all COVID-19 deaths have taken place in nursing homes and assisted living facilities.

(Among states reporting their death totals, 42% of COVID deaths have taken place in long-term care facilities; we estimate the share as 43% for the full U.S. population, based on incorporating the demographics of the non-reporting states.)

Let that sink in: 43% of all COVID-19 deaths are taking place in facilities that house 0.62% of the U.S. population.

And 43% could be an undercount. States like New York exclude from their nursing home death tallies those who die in a hospital, even if they were originally infected in an assisted living facility. Outside of New York, more than half of all deaths from COVID-19 are of residents in long-term care facilities."

"The tragedy is that it didn’t have to be this way. On March 17, as the pandemic was just beginning to accelerate, Stanford epidemiologist John Ioannidis warned that “even some so-called mild or common-cold-type coronaviruses have been known for decades [to] have case fatality rates as high as 8% when they infect people in nursing homes.” Ioannidis was ignored.

New York, New Jersey, Michigan forced nursing homes to accept infected patients

Instead, states like New York, New Jersey, and Michigan actually ordered nursing homes to accept patients with active COVID-19 infections who were being discharged from hospitals.
The most charitable interpretation of these orders is that they were designed to ensure that states would not overcrowd their ICUs. But well after hospitalizations peaked, governors like New York’s Andrew Cuomo were doubling down on their mandates.

As recently as April 23, Cuomo declared that nursing homes “don’t have a right to object” to accepting elderly patients with active COVID infections. “That is the rule and that is the regulation and they have to comply with that.” Only on May 10—after the deaths of nearly 3,000 New York residents of nursing homes and assisted living facilities—did Cuomo stand down and partially rescind his order."


"Why Florida has performed better with vulnerable seniors

Contrast the decisions by governors like Cuomo with those of Florida Gov. Ron DeSantis. In Florida, all nursing home workers were required to be screened for COVID-19 symptoms before entering a facility. On March 15, before most states had locked down, DeSantis signed an executive order that banned nursing home visitations from friends and family, and also banned hospitals from discharging SARS-CoV-2-infected patients into long-term care facilities.

“Every day on these calls [with hospitals], I would hear the same comments and questions around, ‘We need to get these individuals returned back to the nursing home,’” said Mary Mayhew, who runs Florida’s Agency for Healthcare Administration. “We drew a hard line early on. I said repeatedly to the hospital, to the CEOs, to the discharge planners, to the chief medical officers, ‘I understand that for 20 years it’s been ingrained, especially through Medicare reimbursement policy, to get individuals in and out. That is not our focus today. I’m not going to send anyone back to a nursing home who has the slightest risk of being positive.’ What we said constantly is let’s not have two cases become 20 or five become 50. If you don’t manage this individual as you return them back, you will have far more being transferred back to the hospital.”

Florida also prioritized long-term care facilities for personal protective equipment, or PPE, with the understanding that it was just as important, if not more so, to protect workers at nursing homes and assisted living facilities. “If I can send PPE to the nursing homes, and they can prevent an outbreak there, that’s going to do more to lower the burden on hospitals than me just sending them another 500,000 N95 masks,” said DeSantis."

"The optimistic take: Those outside of nursing homes are at lower risk

There is one silver lining—or perhaps bronze lining—to the COVID long-term care tragedy. The fact that nearly half of all COVID-19 deaths have occurred in long-term care facilities means that the 99.4 percent of the country that doesn’t live in those places is roughly half as likely to die of the disease."