COVID-19 Deaths Climb in Nursing Homes as Many Are Behind on Vaccinations, AARP Analysis Finds

More increases are also predicted for the coming months

Emily Paulin, AARP

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En español

Published September 15, 2022

The COVID-19 death rate in U.S. nursing homes has increased for the fourth month in a row, a new AARP analysis of federal data shows. As deaths mounted, COVID-19 booster rates continued to lag, as they have for months, leaving many residents and staff without crucial protection.

The analysis also found that almost half of all residents nationwide — 44 percent — were not up to date with their COVID-19 vaccination as of August 21. That means they’re either not fully vaccinated or are overdue for a booster shot. In some states, as many as 65 percent of residents were not up to date on shots.

More than 1,000 nursing home residents died from COVID-19 during AARP’s most recent four-week analysis, which ended August 21. That’s a decrease in resident deaths since omicron’s winter surge, when roughly 4,000 died during the four weeks ending mid-February, but marks a quadrupling of deaths compared to the four-week period ending April 17. Staff deaths have also quadrupled over the same period, with more than 100 staff deaths reported in the most recent four-week analysis.

The recent deaths bring the total number of U.S. nursing home deaths from COVID-19 to more than 175,000, which is likely an undercount, given the lack of reporting in the early months of the pandemic. These deaths account for roughly a sixth of all COVID-19 deaths in the U.S., even though nursing homes house less than 1 percent of the entire U.S. population.

The death rate is likely to continue to rise in weeks ahead, says AARP’s Ari Houser, a senior methods adviser and coauthor of the analysis, given that the infection rates rose throughout the most recent four-week period. More than 100,000 new COVID-19 cases were reported, up about 15 percent from last month’s analysis. About one in every 22 residents newly tested positive for the virus, while about one worker for every 20 residents did. That’s up from around one resident case and one staff case for every 200 residents in the four weeks ending April 17.

Booster rates still lag

This month’s analysis includes, for the first time since AARP started its monthly looks at nursing home vaccination rates in June 2021, estimates of the percentage of nursing home residents who are “up to date” on COVID-19 vaccination.

While slightly over half of residents nationwide were up to date on their COVID-19 vaccinations, there was huge variation among individual states. In Arizona, only 35 percent of residents were up to date on vaccinations as of August 21, the lowest rate in the country. Meanwhile, 81 percent of residents were up to date in Hawaii, the highest rate in the country.

Check the vaccination rates of your nursing home

You can check the vaccination rates of residents and staff at any Medicare-certified nursing home, and compare them with state and national averages, on Medicare.gov’s Care Compare website.

1. Find a nursing home’s profile via the home page’s search function.

2. Visit the Details tab on its profile.

3. Click the View COVID-19 Vaccination Rates button.

The analysis shows that uptake of first booster shots has been lagging among workers, with only about half of all workers nationwide — or roughly a million — vaccinated and boosted as of August 21. The CDC recommended that most nursing home workers get an initial booster late last year. But unlike initial series vaccinations, which the federal government requires for all staff of Medicare- and Medicaid-funded health care facilities, boosters aren’t mandated.

There’s wide variation in booster uptake among workers in different states, with a low of 31 percent of nursing home workers boosted in Mississippi. Meanwhile, 96 percent of such workers are boosted in Massachusetts, where the state requires boosters for all nursing home workers.

Earlier this month, the Centers for Disease Control and Prevention (CDC) recommended new bivalent boosters for those who are at least two months past their last shot, which epidemiologists are encouraging members of the nursing home community — residents, staff and visitors — to get. COVID-19 cases are expected to increase in the fall, which could coincide with a potentially nasty influenza season, based on the Southern Hemisphere’s rough winter. The CDC’s recently updated COVID-19 guidance, which is more relaxed, may also contribute to more cases.

Staffing shortages persist

AARP’s analysis also found that staffing shortages in nursing homes, which one expert called a “staffing apocalypse,” show no signs of letting up.

Check the staffing rates of your nursing home

You can find staffing data — including staff turnover rates, average hours of care provided to residents by different types of nurses, and weekend staffing levels — for any Medicare-certified nursing home, and compare them with state and national averages, on Medicare.gov’s Care Compare website:

1. Find a nursing home’s profile via the home page’s search function.

2. Visit the Ratings tab on its profile.

3. Under Staffing, click View Staffing Information.

About a quarter of all nursing homes nationwide reported a shortage of nurses or aides in the four weeks ending August 21. The percentage of U.S. nursing homes reporting a shortage rose to this level during last summer’s delta wave and has remained there or higher ever since.

More than 50 percent of facilities in Alaska, Kansas, Maine, Minnesota, North Dakota, New Hampshire, Washington and Wyoming reported shortages.

AARP’s analysis, conducted by the AARP Public Policy Institute and the Scripps Gerontology Center at Miami University in Ohio, draws primarily on data acquired from the Nursing Home COVID-19 Public File by the Centers for Medicare & Medicaid Services. Most nursing homes are federally certified and required to submit data to the government each week.

The ongoing analysis captures data only from federally certified nursing homes, not from all long-term care facilities — such as assisted living, independent living, memory care and others — as some other tallies do. An updated analysis will be released next month as new federal data becomes available. Read more about the analysis.

Emily Paulin is a contributing writer who covers nursing homes, health care, and federal and state policy. Her work has also appeared in Broadsheet, an Australian lifestyle publication.

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