How bad was the covid-19 pandemic for nursing homes residents? A new government study finds that 40 percent had the virus, or probably did. About 169,000 more Medicare residents died in the pandemic year of 2020 than in 2019, an increase in the overall death rate of about 32 percent. And in April 2020, about 1,000 more Medicare residents were dying every day than in April 2019.
Because it was so difficult to identify covid-19 deaths in the early days of the pandemic, the study by the inspector general of the federal Department of Health and Human Services relied heavily on an analysis of excess deaths. In other words, how many more people died than analysts expected, based on past experience.
That doesn’t mean that every additional death was due to covid-19, but it is strong evidence of the toll the disease took among nursing home residents. That’s especially true since there was no other obvious reason why so many more people died in 2020 than in 2019. And it opens a window into another critical question: How many residents died of conditions that were related to covid-19 but not directly from the virus itself.
For example, researchers are trying to determine how many long-term care residents died prematurely from the effects of loneliness or social isolation while residents were effectively locked down in their rooms in an attempt to stop the disease’s spread. Studying excess deaths can help explain that phenomenon.
Overall, 22 percent of nursing home residents died in 2020, nearly one-third higher than the 17 percent who died in 2019.
Deaths came in two big spikes. First in April, 2020, and again at the end of the year. In April and December more than 6 percent of nursing home residents on Medicare died, far higher rates than in the previous year. The 2019 death rates for those months were 3.5 percent and 3.8 percent.
The second spike was especially troublesome since it suggested many lessons of April—the need for better masking and other personal protection and the importance of rapid testing of residents and staff—apparently failed to reduce death rates eight months later. How that happened will be the subject of much study in coming years.
The percentage of covid-19 cases did not differ much by age or gender—roughly four in ten residents in all age groups 65 or older likely caught covid-19, as did about 40 percent of men and 40 percent of women.
Race seemed to matter. About half of Black residents had or probably had the virus, while the disease infected only about 40 percent of White residents. That may have been related to the location of facilities since several studies have shown that those located in communities with high rates of the virus were more likely to have outbreaks. And the percentage of cases in Black communities was higher.
The oldest and most frail
When it came to deaths, age made a big difference. About 12 percent of those 65 or younger died in 2020, compared to 8 percent in 2019. But 30 percent of residents over 85 passed away in 2020.
Race mattered less. About one-quarter of White, Black, and Hispanic residents died in 2020, compared to about 27 percent of Asian residents, though the increase in the percentage of deaths for White residents was somewhat lower than for other races. Men were somewhat more likely to die than women.
The other big difference was between nursing home residents on Medicare only and those who were eligible for both Medicare and Medicaid. These “dual eligibles” are among the most frail nursing home residents, and are most likely to be living with multiple chronic conditions. And, not surprisingly, their deaths rates rose significantly from 19 percent in 2019 to 26 percent in 2020. By contrast, about 19 percent of Medicare only residents died in 2020, compared to 16 percent in 2019.
The study also showed how the virus exploded in nursing facilities in the spring of 2020 and again in the late fall. In March, 492 Medicare beneficiaries in nursing homes were newly diagnosed as having or likely having covid-19 every day. Just a month later, that daily number of new cases rose to 4,700. By December, daily new cases topped 6,600 and the total cases reached 1.3 million.
We still have much to learn about the effects of covid-19 on older adults. But this new HHS study of excess deaths gives us a clearer picture of the terrible consequences of the disease on nursing home residents.