The inquiry that led to this posting started with the question: where and why are Americans dying from the COVID-19 virus? Frail older people with underlying health conditions have died in disproportionate numbers.
State health departments have been inconsistent or, in the case of New York State, incomplete in reporting COVID-19 nursing home deaths, but the compiled national reporting on nursing home deaths indicate that approximately 40% of all COVID-19 deaths have occurred in nursing homes or to nursing home residents in hospitals.
But this is only part of the answer. In many states, they account for over half of the deaths, but the death rates are very unevenly distributed.
In Connecticut, 16 of 212 nursing homes had recorded no deaths through mid-January, 2021, while 13 had deaths exceeding 40% of the resident census.
The narratives as to why this is happening have also been incomplete and, arguably, false and misleading. While early studies seemed to show that more residents died in for-profit nursing homes, the conclusions from multiple studies conducted over a longer period are far more inconclusive.
There appears to be no or little correlation with Medicare Star ratings for nursing homes, or with the number and severity of inspection violations. There is some evidence that the age of the facility correlates with more deaths, but even that data is not compelling.
The best hypotheses from research, much of which was conducted outside the United States, is that these factors had the highest impact on death rates:
- Severe overcrowding (nursing homes with predominantly two or more residents per room);
- “Unhealthy buildings,” that is, buildings with poor ventilation, air filtration and disinfection; and
- Leadership and staffing which was either untrained in or inadequately focused on basic infection control processes, such as mask wearing, frequent testing of staff, or failure of staff to enforce physical distancing guidelines among residents.
We are drowning in reporting and measurement on many variables, but we have no data that enables insights on these likely causes of COVID-19 transmission and death rates in nursing homes.