More than two years into the COVID-19 pandemic — and amid another nationwide surge — nursing home residents are still disproportionately at risk for severe illness and death, according to new numbers from AARP.
One in 35 nursing home residents tested positive for COVID-19 in June, a 27 percent increase from the previous month. The death rate from COVID between May and June of this year nearly doubled, from 0.04 deaths per hundred residents to 0.07 deaths per hundred residents.
Ari Houser is a senior methods advisor for AARP’s Public Policy Institute and the lead analyst for AARP’s nursing home dashboard, which tracks COVID cases, deaths and vaccination rates among both residents and staff.
“The number of cases is pretty high. It’s as high as it was during the summer and fall of 2020, before there was a vaccine. It’s higher than it was during the Delta wave last year,” Houser told The 19th.
Houser realized early in the pandemic that nursing homes would face unique, elevated risks compared to the general population. “People in nursing homes are vulnerable. There’s so many people. They’re in these facilities together. Staff are going around from room to room. It’s not like an apartment where people can isolate and close the door,” he said.
Nationally, COVID infection rates were up 24 percent in June, but nursing home residents are at significantly higher risk of severe disease and death than the general population due to age and disability, according to the Centers for Disease Control and Prevention.
It’s difficult to make a direct comparison in rates between nursing homes and the general population because of differences in data collection. While health officials regularly track facilities’ COVID data, many Americans use home tests and do not necessarily report their results to their local health departments.
Cases were also up 42 percent among staff, according to the AARP data. The majority of nursing home staff are women, disproportionately women of color, according to the nonpartisan Kaiser Family Foundation.
While deaths at nursing homes are higher than they have been in previous months, they are not as high as they were early in the pandemic, which Houser attributes to high vaccination rates in nursing homes: On average across the country, 88 percent of residents and 89 percent of nursing home staff have received their primary series of COVID-19 vaccines.
“I don’t envision another month where we have upwards of 20,000 people dying [like early in the pandemic],” he said.
However, low and slow-to-rise rates of booster vaccinations, particularly among staff, are a concern. According to AARP, only 51 percent of nursing home staff have received a booster as of June. Seventy-two percent of nursing home residents have received a first booster nationwide.
There is not yet enough data to track second boosters among residents and staff, though Houser anticipates having second booster numbers in the coming months.
“Just about everyone [living] in a nursing home is eligible for a second booster and so are a lot of the staff,” Houser said.
Booster rates for both residents and staff vary widely depending on the state. In Florida, only 59 percent of nursing home residents have received boosters. In New York, 77 percent of residents have received a first booster — above the U.S. average of 71.6 percent.
Most nursing homes nationwide do not require boosters and there is currently no national mandate.
According to the CDC, the vaccine provides excellent protection against severe disease and death. However, it has been less effective in protecting against mild and moderate disease from newer variants of the virus. It is still unclear if vaccination reduces risk of post-COVID complications.
Donna Gregory, 53, works for a nursing home in Cheektowaga, New York, a suburb of Buffalo. She remembers the horror of the early pandemic: “It was horrible. We lost so many residents,” she said.
Staff from local funeral homes refused to enter out of fear, so Gregory and other nursing home staff were responsible for putting residents into body bags — when they were even available.
“We had to be the undertakers. We had to put [disinfecting] spray in their mouths. [If there were no body bags] we’d cover their faces with a pillowcase or a towel. Then we’d put them on the gurney and take them to the door,” Gregory recalled.
While cases are currently up in Gregory’s nursing home, the situation is not as dire as it was then. “There’s no comparison,” she said.
Gregory is fully vaccinated and boosted — her nursing home requires it of staff. She contracted COVID-19 for the first time this January during the first Omicron wave.
Gregory described her initial COVID infection as relatively mild and flu-like. However, she has since been hospitalized twice for heart problems, including one night in the intensive care unit.
“I’ve seen a cardiologist and the only thing they can tell me was that it may be due to the virus,” Gregory said. People who have had COVID-19 appear to be at higher risk of developing heart problems, but the reasons are not yet well understood.
One thing that is different about the current wave, according to Houser: It’s everywhere.
“When numbers are low in one area of the country, it really just means that the impacts happened last month, or they’re going to happen next month,” he said.
Houser also encouraged caution when it comes to praising any particular state’s handling of the pandemic.
“There’s a desire, if a particular state is doing well at this point in time, to attribute low cases in that state to something that state has done,” he said. “I don’t think it has anything to do with that…The reality is that it’s everywhere. There’s no state that’s being spared from the virus.”