5.1 million people in the United States live in nursing homes or residential care facilities.
The elderly residents of those facilities represent 1.6% of the U.S. population, but they account for nearly 40 percent of all deaths from COVID-19.
This stunning bit of information, which you’d think every journalist and politician in the country would be publicizing to the rooftops by now, is from an article in Medium.com by the public policy think tank FREOP:
The headline says it all:
“COVID-19 Nursing Home Crisis by the Numbers: A startling statistic has profound implications for the way we’ve managed the coronavirus pandemic.”
It’s not just dense places like New York City and northern New Jersey that have had such high percentages of their fatalities in nursing and care homes.
It’s states like Minnesota — 82% of its deaths are from nursing homes. New Hampshire — 72%. My home state of Pennsylvania — 67% statewide and about 80 percent in Western Pennsylvania, which the pandemic has otherwise virtually never arrived.
This map is shocking.
An online spread sheet here crunches each state’s numbers.
The USA is not alone, the authors point out, Europe is even worse at keeping their old folks safe:
The U.S. is not an outlier in terms of its nursing home-related COVID-19 fatalities. A study by researchers at the International Long Term Care Policy Network of fatalities in Australia, Belgium, Canada, Denmark, France, Germany, Hong Kong, Hungary, Ireland, Israel, Norway, Portugal, Singapore, and Sweden found that 49.4 percent of reported COVID-19 fatalities took place in nursing homes.

 

Since the article is posted on Medium.com, I can post the entire thing here.

 

freopp.org

Nursing Homes & Assisted Living Facilities

Account for 39% of COVID-19 Deaths

A startling statistic has profound implications for the way we’ve managed the coronavirus pandemic.

 

By Gregg Girvan and Avik Roy

Based on a new analysis of state-by-state COVID-19 fatality reports, it is clear that the most underappreciated aspect of the novel coronavirus pandemic is its effect on a specific population of Americans: those living in nursing homes and assisted living facilities.

The disease caused by SARS-CoV-2 affects the elderly far more severely, on average, than younger individuals.

But it turns out that among those who are elderly, deaths are concentrated even further among those living in long term care facilities. This has implications for both those who live in such facilities and those who don’t.

 

40 percent of U.S. COVID-19 deaths have occurred in nursing homes and assisted living facilities. Nursing homes are residential facilities for those needing 24/7 on-site medical supervision; assisted living facilities are for those not needing 24/7 medical supervision. The share of deaths occurring in nursing homes and assisted living facilities is highest in Minnesota, at 84 percent, using the latest data as of May 11, 2020. (Source: G. Girvan / FREOPP; Graphic: A. Roy / FREOPP)

Five categories of long-term care providers

There are five core categories of long-term care providers, of which two are our focus: nursing homes and residential care communities.

  • Nursing homes. Nursing homes, also known as skilled nursing facilities or SNFs, include 24-hour supervision, nursing care, three meals a day, and assistance with activities of daily living. Nursing home residents are usually people with long-term physical, medical, or mental conditions requiring 24-hour supervision, but can also include patients recently discharged from a hospital who need such care temporarily.
  • Assisted living facilities. Assisted living facilities, sometimes called residential care homes or personal care homes, are similar to nursing homes, but for individuals who don’t require full-time medical care on-site. They offer meals and assistance with activities of daily living.
  • Adult day service centers. Adult day service centers, sometimes called adult day care, are usually only open during normal business hours, and offer a lighter menu of services for those needing some assistance.
  • Home health care. Home health care, often delivered through agencies, offer services similar to those of nursing homes but in an individual’s home.
  • Hospices. Hospices are long-term care facilities for those with terminal illnesses (e.g., those with 6 months or less to live).

According to the Centers for Disease Control and Prevention, 5.1 million people live in nursing homes or residential care facilities, representing 1.6% of the U.S. population. And yet residents in such facilities account for 40 percent of all deaths from COVID-19, for states that report such statistics.

 

 

For more on reopening the economy while the pandemic endures, read FREOPP’s white paper, “A New Strategy for Bringing People Back to Work During COVID-19,” by Lanhee Chen, Bob Kocher, Avik Roy, and Bob Wachter.

Alaska, Hawaii, Kansas, Michigan, Missouri, New Mexico, North Dakota, South Dakota, Utah, Vermont, and Wyoming do not break out deaths by residential categories. But among the 67,533 U.S. COVID-19 deaths captured by our analysis, 26,778, or 40 percent, were nursing or residential care home residents. Based on long-term care usage and demographics in the 11 largely rural states that do not report long-term care fatalities, we estimate that, nationally, the share of fatalities from nursing home and residential care facilities is 40 percent, and 51 percent outside of New York State.

Our calculations are available in an online spreadsheet for public review. We estimate the national share of nursing and residential care home COVID-19 fatalities in three ways:

  • Estimate 1 (40.6%): Among states reporting nursing home fatalities, death from COVID-19 has struck 0.52% of U.S. residents of nursing homes and residential care facilities. We estimate that 5.1 million Americans over 65 live in nursing homes and residential care facilities; by extrapolating 0.52% across the entire U.S. nursing and residential care home population, we estimate that nursing homes account for 40.6% of COVID-19 fatalities.
  • Estimate 2 (39.7%): This is our most simplistic estimate. Among states reporting nursing and residential care home fatalities from COVID-19, nursing homes account for 39.7% of those deaths. If we simply assume that this share holds true in non-reporting states, we get to a national share of 39.7% (i.e., identical to the share in reporting states).
  • Estimate 3 (51.0%): This estimate excludes New York State, which is an outlier in terms of its reported share of COVID-19 deaths in nursing homes. A number of policymakers in New York have alleged that nursing home facilities in that state have been underreporting their COVID-19 fatality figures, possibly because New York State counts as hospital deaths those of nursing home residents who die in a hospital.

Similar figures outside the U.S.

The U.S. is not an outlier in terms of its nursing home-related COVID-19 fatalities. A study by researchers at the International Long Term Care Policy Network of fatalities in Australia, Belgium, Canada, Denmark, France, Germany, Hong Kong, Hungary, Ireland, Israel, Norway, Portugal, Singapore, and Sweden found that 49.4 percent of reported COVID-19 fatalities took place in nursing homes.

There are idiosyncrasies in the way that U.S. states and other countries report nursing home fatalities; we will update this article when improved reconciliation becomes feasible.

Reorienting the COVID-19 policy response

The policy implications of these figures are significant, and suggest substantial flaws in the way that we have managed the COVID-19 pandemic. Much more attention must be paid to the risk of SARS-CoV-2 infection in nursing homes, especially through nursing home staff who work at multiple facilities. Nursing homes must use best practices for testing and cleanliness.

 

The risk of death from COVID-19 is far higher in the elderly than in younger Americans. According to data from the Centers for Disease Control and Prevention, there have been 23 deaths associated with COVID-19 per million people among those aged 25 to 54, whereas there have been 566 deaths per million among those over 65: a 25-fold difference. Note that not all COVID-19 deaths reported elsewhere are counted by CDC, and that not all CDC-counted deaths were caused by COVID-19; some of these individuals died from other causes, but tested positive for SARS-CoV-2 antibodies. (Graphic: A. Roy / FREOPP.)

On the flip side, it would appear that elderly individuals who do not live in nursing homes may be at a somewhat lower, while still significant, risk for hospitalization and death due to COVID-19. States and localities should consider reorienting their policy responses away from younger and healthier people, and toward the elderly, and especially elderly individuals living in nursing homes and other long-term care facilities.

Posted in Covid-19, Nursing homes and tagged , , , ,

Leave a Reply