How COVID-19 has impacted American nursing homes

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November 21, 2020
John Tlumacki/The Boston Globe // Getty Images

How COVID-19 has impacted American nursing homes

Many of the most poignant and searing images of the coronavirus pandemic are those of family and friends visiting isolated nursing home residents, who peer back through windows or plexiglass dividers. Some wear brave smiles. Others look forlorn and bewildered.

The virus has taken hard aim at the nation’s 2.1 million residents who live in nursing homes and assisted living facilities, and the 3 million workers who care for them. Stacker compiled a list of 25 ways that COVID-19 has had an impact on the nation’s nursing homes, by consulting news reports, trade and industry guidelines, scientific studies, and orders issued by state and federal governments.

Elderly and frail long-term care residents are disproportionately falling sick and dying. Many have pre-existing conditions—including as many as two-thirds of people age 70 or older—that make them particularly vulnerable. But too many have fallen needlessly sick, victims of neglect and greed by nursing home operators who have fallen far short in their care and compassion. And too many have died as the result of poor state and federal policy that could have protected them.

At a soldiers’ home in Massachusetts, veterans who survived Omaha Beach on D-Day and fought in Vietnam died by the dozens in the virus’ unrelenting spread. Decisions made by the home’s administration were later described in a government investigation as “utterly baffling,” and two former administrators face a host of criminal charges.

A public health official in Los Angeles County told families their loved ones might be better off at home than in local nursing homes, where more than 120 had infectious outbreaks. A nurse tried to tell the world about the failures and lack of care at the home where she worked, and she ended up dying of the virus herself.

The Centers for Medicare and Medicaid Services, the federal agency that oversees nursing homes, has come under heavy fire for doing too little, too late to protect the residents and staff at the more than 15,600 nursing homes across the country.

More than a quarter of the nation’s COVID-19-related deaths have occurred among residents and staff at long-term care facilities, and in several states, deaths in long-term facilities account for more than half the state’s total fatalities.

Keep reading to discover how COVID-19 has impacted American nursing homes.

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Outbreak in Kirkland, Washington

Feb. 26 - The first concentrated outbreak of COVID-19 in the United States involved the deaths of two residents of Life Care Center in Kirkland, Washington. On Feb. 28, tests confirmed they had the disease.

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Nursing home visits banned nationwide

March 14 - The federal government banned all non-essential visits to nursing homes. It also ordered the total suspension of all group activities in nursing homes.

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Federal oversight agency focuses on infection control

March 20 - The Centers for Medicare and Medicaid Services, the federal agency that oversees nursing homes, announced a halt to all state surveys of facilities, to be replaced by targeted infection control surveys. Meanwhile, the federal government waived the requirement that nurse’s aides have 75 hours of training and instead allowed people with eight hours of online study to become caregivers. The industry had long sought a waiver, saying the standards were difficult for recruitment.

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Veterans die of COVID-19 at Massachusetts home

March 23 - Massachusetts officials announced the first case of COVID-19 at Holyoke Soldiers’ Home, where eventually some 76 veterans died of the virus. By the end of March, facility superintendent Bennett Walsh was placed on paid leave. On April 8, the Massachusetts state attorney general’s office opened an investigation into the Holyoke Soldiers’ Home and its deadly COVID-19 outbreak.

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New York orders nursing homes to accept COVID-19 patients

March 25 - New York state required nursing homes to accept COVID-19 patients who have been discharged from hospitals. The policy was said to advocate for patients needing care, but nursing homes were soon hit by outbreaks and higher death tolls. On March 31, New York Gov. Andrews Cuomo added a provision to the state’s budget negotiations to shield nursing homes and hospitals from lawsuits that claim they failed to protect patients from COVID-19. The provision is retroactive to March 7.

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Los Angeles County suggests taking loved ones home

April 7 - The public health director of Los Angeles County told families to consider removing loved ones from long-term facilities to help protect their health. More than 120 facilities in the county are believed to have outbreaks of coronavirus. The following day, in California’s Riverside County, more than 80 residents were removed from the Magnolia Rehabilitation and Nursing Center when more than a dozen employees missed two consecutive days of work.

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California governor orders nursing home residents transferred to Navy ship

April 10 - California Gov. Gavin Newsom ordered the transfer of some healthy nursing home residents to the U.S. Navy hospital ship Mercy at the Port of Los Angeles to avoid exposure to coronavirus at affected facilities. The same day, the state of California sent 600 specialized nurses trained in infectious disease control to nursing homes and adult-care facilities to help with infected residents. The state has more than 1,200 skilled nursing facilities.

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Nursing homes get COVID-19 test payments

April 15 - The Centers for Medicare & Medicaid Services increased payments to nursing homes for COVID-19 tests. It says Medicare will nearly double payment for certain testing in an effort to diagnose large numbers of cases rapidly.

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Whistleblower nurse dies of COVID-19 in Massachusetts

April 10 - In Littleton, Massachusetts, a nurse who acted as a whistleblower about conditions at a nursing home died of coronavirus. She had publicly accused the Life Care Center of Nashoba Valley of failing to handle the crisis and failing to be upfront with staff and residents. 

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Bodies discovered at New Jersey nursing home

April 13 - Acting on an anonymous tip, police discovered 17 bodies in bags at the 543-bed Andover Subacute and Rehabilitation Center II in New Jersey. The facility had been cited for overcrowding and sanitary conditions. By early May, 94 of the 133 residents who tested positive for COVID-19 were dead. On May 8, the nursing home was fined more than $220,000 by the Centers for Medicare & Medicaid Services for violating infection prevention and control regulations.

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Michigan orders nursing homes to build COVID-19 units

April 15 - Michigan Gov. Gretchen Whitmer ordered nursing homes and other long-term care facilities to create separate units for residents with coronavirus or send them to a local facility that has a unit. Any facility that is less than 80% full is required to set up such a unit to help stem the spread.

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US government requires reporting of nursing home COVID-19 cases

April 19 - The U.S. Centers for Medicare & Medicaid Services announced a requirement that nursing homes report any COVID-19 cases and deaths to local and state health departments and to the U.S. Centers for Disease Control and Prevention. The regulatory requirements also call for nursing homes to inform residents and family members of COVID-19 cases in the facilities.

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Report finds 27% of all COVID-19 deaths are in long-term care facilities

April 23 - The Kaiser Family Foundation, a non-profit organization that focuses on national health issues, released a report showing that, based on data from 23 reporting states, 27% of the nation’s COVID-19-related deaths occurred in long-term care facilities among residents and staff. In six states reporting data—Delaware, Massachusetts, Oregon, Pennsylvania, Colorado, and Utah—deaths in long-term care facilities accounted for more than half of the fatalities.

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Maryland mandates statewide nursing home testing

April 29 - Maryland said it would require the testing of all nursing home residents and staff for coronavirus. Officials said it was believed to be the country’s first such state mandate. More than half of the state’s coronavirus-related deaths are connected to skilled-nursing facilities, data shows.

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New York state backtracks on nursing home order

May 10: The New York Department of Health rescinded its March 25 order that required nursing homes to accept aged COVID-19 patients discharged from hospitals. The reversal came after the original order was criticized for contributing to, not alleviating, death tolls. Gov. Andrew Cuomo ordered twice-weekly testing of nursing home and adult care facility staff.

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U.S. agency advises on easing visitation restrictions

May 18 - The federal Centers for Medicare & Medicaid Services (CMS) issued recommendations on how nursing homes can relax restrictions on visitation. It says the guidance aims to address rigorous infection prevention and control as well as residents’ social engagement and quality of life.

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$4.9 billion distributed to skilled nursing facilities

May 22 - The federal Department of Health and Human Services announced the distribution of nearly $4.9 billion in COVID-19 relief funds directed at skilled nursing facilities, the first such specified payment since the pandemic began. It said every skilled nursing facility nationwide would get a minimum of $50,000 and an additional $2,500 per bed. That same day, The Journal of the American Medical Association released a report finding nursing home residents comprise about a quarter of documented COVID-19-related deaths despite accounting for fewer than 0.5% of the U.S. population.

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Rapid testing reaches nursing homes in COVID-19 hot spots

July 14 - The U.S. Department of Health and Human Services announced distribution of rapid diagnostic tests to nursing homes in COVID-19 hot spots for on-site testing of staff and residents. The nasal swab-type tests are the type that can provide results within minutes.

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Two-thirds of people 70 and older are at higher risk for severe COVID-19 symptoms

Aug. 1- A study published in The Lancet medical journal says two-thirds of people age 70 or older have at least one underlying condition putting them at increased risk of severe COVID-19 if they get infected. That rate compares with about 5% for people under age 20 and about 22% of the global population overall, it said.

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NASEM makes recommendations for ‘tier one’ population at high risk for COVID-19

Oct. 2 - The National Academies of Science, Engineering and Medicine (NASEM) issued a recommendation that nursing home workers and residents be among the “tier one” population that is considered at high risk for the virus, part of its study on who should have access to a vaccine and in what order. The organization does not set policy, but is highly influential among federal decision makers.

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COVID-19 deaths in Indiana nursing homes are 58% of state total

Oct. 7 - The number of nursing home deaths surpassed 2,000 in Indiana, one of the states where nursing homes were hardest hit. Officials say deaths in nursing homes and long-term care facilities comprise about 58% of the state’s COVID-related fatalities. The state’s first nursing home death was reported on March 20; for 35 consecutive days, from mid-April to late May, at least 20 long-term care residents died every day across the state.

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New Jersey recalibrates ratio of nursing home residents, aides

Oct 23 - New Jersey Gov. Phil Murphy signed a bill requiring nursing home operators as of early 2021 to increase the number of aides and set a ratio for the number of residents per aide. Industry lobbyists had long blocked the measure prior to the pandemic.

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Performance payments issued to nursing homes

Oct 28 - The Department of Health and Human Services distributed a first round of $333 million in performance payments to more than 10,000 nursing homes as recognition for showing significant reductions in COVID-19 cases and deaths between August and September. More than 77% of the 13,795 eligible nursing homes met the criteria for infection control. To be eligible, nursing homes had to have an infection rate lower than that in their county and a mortality rate of less than 10% among residents that contracted COVID-19. Over the summer, the Journal of the American Medical Association Network published a study finding the staffing performance at facilities is one of the best predictors of coronavirus cases.

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CMS toolkit seeks to ‘rebalance’ long-term care

Nov 2 - The Centers for Medicare & Medicaid Services unveiled a toolkit for ways that states can practice “rebalancing”—moving money to community programs and away from brick-and-mortar nursing homes. The moves are argued to be less costly and more popular among the public.

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COVID-19 cases in nursing homes on rise again across U.S.

Nov. 10 - The American Health Care Association and National Center for Assisted Living, representing more than 14,000 nursing homes and assisted living facilities, issued a report warning that COVID-19 cases are increasing in nursing homes. It said a rise in nursing home cases was linked to a spike in the general population. It also says nursing home residents are so vulnerable that they account for just 8% of COVID cases but 40% of the deaths.

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