Nearly 26,000 Nursing-Home Residents Died of Covid-19, U.S. Tally Shows

The first major federal effort to measure the deadly impact of the new coronavirus in nursing homes found around 26,000 deaths, a total that likely falls short of showing the full toll on some of the most vulnerable Americans.

The new survey of nursing homes, released Monday by the Centers for Medicare and Medicaid Services, showed 25,923 resident deaths tied to Covid-19, the disease caused by the virus, and 449 deaths among the facilities’ staff. The survey also found about 95,000 infection cases at nursing homes across 49 states, about a third of them among staff members.

But the CMS rule that mandated the data collection, issued May 8, didn’t require nursing homes to report deaths and cases that occurred before early May. Also, assisted-living facilities, which aren’t regulated by CMS, didn’t have to submit any information, though they could do so voluntarily.

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CMS Administrator Seema Verma said the agency believed that the “vast majority” of nursing homes had provided data from before May 8, though CMS said about 20% of the nation’s 15,400 nursing homes had not reported required data by May 24. Ms. Verma said CMS couldn’t require the facilities to report information from before the rule took effect. 

 
Nursing homes and other types of elder-care facilities have been major hot spots for deadly Covid-19 outbreaks around the U.S., particularly in populous regions such as the Northeast, which have spent months battling significant outbreaks.

A Wall Street Journal tally of state data from around the U.S. shows more than 42,000 Covid-19-associated deaths in long-term-care facilities, including nursing homes and assisted-living sites, along with more than 200,000 cases. This tally, too, likely undercounts the full impact of the outbreak because of reporting lags and incomplete information from some states.

In total, more than 104,000 deaths nationwide are linked to Covid-19, according to a count by Johns Hopkins University.

Nursing homes have been particularly vulnerable to the highly contagious virus because of their setup, with elderly, frail residents often living in shared rooms, in close contact with staff who can become infected without showing symptoms.

CMS said Monday it is increasing penalties for nursing homes with persistent infection-control violations and taking more actions on lower-level infection problems.

States have gradually improved their own reporting on the crisis in these facilities. Still, the federal-level count was meant to fill in the gaps because states have widely varying methodologies and levels of disclosure.

Later this week, CMS said it would release data searchable by individual facility, which hadn’t been available to consumers in a number of states, including Texas, Missouri and Arizona. The data will be updated weekly, the agency said.

The early federal data show some shortfalls compared with information that states have released thus far, some of which is more recent. California’s Department of Public Health, for example, counted 1,856 Covid-19-related deaths in skilled-nursing facilities by Monday. The federal survey counted 1,184 in California nursing homes. The state of Connecticut recently reported 2,398 nursing-home deaths, far above the 1,500 thus far included in the federal data set.

The 5,944 confirmed and presumed nursing home deaths counted by state authorities in New York are roughly double the number tallied by the federal survey. New York limits its own nursing-home data by leaving out cases in which residents died in the hospital. The federal survey asked nursing homes to include such cases.

The federal survey also asked for reports of probable Covid-19-related deaths, which often reflect cases in which there is clinical evidence of the disease despite the lack of confirmatory laboratory results, although CMS said lack of testing may limit reporting. The Centers for Disease Control and Prevention counts these cases, and many of the nursing-home cases in New York are what the state calls presumed Covid-19 deaths.

Comparisons with the newly released federal data are difficult in many other states that blend nursing home reports with reports from other kinds of long-term-care facilities.

The federal data are likely to leave the full picture of the virus’s fatal effects in U.S. nursing homes incomplete, researchers said. CMS has suspended some other traditional forms of surveillance, citing the need to reduce burdens on the facilities. In March, the agency waived requirements that nursing homes submit detailed staffing data.

“We won’t be able to see what was going on,” said Tamara Konetzka, a professor of health-services research at the University of Chicago. “We’ll have a data gap during this time.”

Using the patchwork of state data, researchers had already been delving into which factors are associated with cases of Covid-19. A new analysis by David Grabowski of Harvard University and others, using data from 30 states, found that the factors most clearly linked with having a Covid-19 case included being in states with significant spread of the virus, an urban location and a greater share of African-American residents. Being a for-profit nursing home was tied to having larger outbreaks, the analysis found.

CMS said its new data showed that nursing homes with low ratings on the agency’s five-star quality scale were more likely to have large numbers of coronavirus cases than those with high ratings.

The Covid-19 risks in nursing homes have been compounded by inadequate testing and personal protective equipment, said Joseph Ouslander, a geriatrician who is a professor at Florida Atlantic University. Though testing requirements are ramping up, nursing homes have been complaining about the cost.

“There are going to be, unfortunately, more and more clusters of infection and death in nursing homes,” said Dr. Ouslander. “It’s going to keep happening.”