So far, the number of nursing home deaths attributed to covid-19 has reached nearly 32,000 residents and more than 600 employees, and both counts are sure to rise: About 12 percent of the nation’s 15,000 homes have not yet reported figures. The new numbers, building on data released Tuesday that showed about 26,000 resident deaths, include the death toll from more homes.
The data offer a statistical portrait of an industry at the center of the pandemic’s fury unable to properly care for its 1.4 million residents: Nearly 2,000 facilities reported a shortage of nursing staff and more than 2,200 said they lack enough aides, according to the data.
The figures on basic supplies are similarly dire: More than 250 nursing homes lack any surgical masks and another 800 are within a week of running out. More than 2,000 are a week away from running out of gowns and more than 800 are a week away from depleting hand sanitizer supplies. More than 500 lack any N95 masks used to prevent infection, according to the data.
"We have failed the residents and we have failed the staff as a society,” said Michael Wasserman, president of the California Association of Long Term Care Medicine.
Nursing homes with stringent infection control and adequate staffing were better equipped to prevent the spread of the coronavirus once it struck, Wasserman said, but even the best nursing homes lacked personal protective equipment and access to testing.
“This is something the CDC should have been studying from the beginning,” he said.
The federal government’s decision to provide information about outbreaks at nursing homes comes after more than a dozen states refused to make public the same information, spurring lawsuits across the United States.
As of the end of May, 14 states were not disclosing information about the pandemic’s impact on nursing homes, according to a survey by USA Today. In some states — including Arizona and Idaho — media organizations have filed lawsuits demanding the information, arguing that the public ought to know which nursing homes have outbreaks. In other states, legal pressure has led to public release of the information. In Florida, for example, state officials released more information following a lawsuit drafted by the Miami Herald and supported by other media organizations including The Washington Post.
The federal government eventually stepped into the dispute, requiring more public disclosure about the nursing home outbreaks. In April, the U.S. agency that oversees nursing homes — the Centers for Medicare and Medicaid Services — issued a rule calling for nursing homes to report information on coronavirus cases and deaths among residents and staff to the agency.
“We wanted to be as transparent as possible with the American people,” CMS Administrator Seema Verma said Thursday.
The data released Thursday covers nearly 9 in 10 of the country’s 15,000 federally certified nursing homes. It does not include assisted-living centers and other types of eldercare facilities not certified and inspected by the CMS. The data includes information on cases and deaths per home as well as shortages of staff and PPE, which some homes have blamed for their high rates of infection.
The data also will be used by researchers to study one of the central mysteries about the ravages of the virus at the nation’s nursing homes: Why did the virus run rampant at some nursing homes, infecting most residents, while at other facilities the effects of the virus have been minimal?
Industry associations have argued that nursing homes are blameless and that no amount of preparation could have prevented an outbreak at any home. Instead, they say, the outbreaks tended to happen at larger homes in communities where the virus is widespread. Some academics agree.
People may “believe the narrative that it’s the nursing home’s fault,” said Vincent Mor, a professor of health services, policy and practices at Brown University. “It’s a narrative that people really want to hear because it’s too frightening to assume that it’s all random.”
But, he said, the likelihood of an outbreak at a home is not about the home’s quality. Instead, he said, the outbreaks reflect “the prevalence of the virus in the county, the size of the home and the population density.”
Verma, of the CMS, on Thursday disputed that assessment. She said many nursing homes that made “stringent efforts” to screen staff and enforce hand-washing and other infection-control measures saw no outbreaks or deaths.
The agency looked at homes with high rates of infection and death and noted that many of them had previously had received poor grades for quality. Other academics, including Charlene Harrington at the University of California at San Francisco and Yue Li at the University of Rochester, have connected the outbreaks to shortages in staffing.
“Not all nursing homes were hit. Not all nursing homes report cases,” Verma said. "They took the appropriate steps and precautions and the virus didn’t spread.”
“Our data shows something very different,” she said.
The industry also has argued that a shortage of supplies and of testing by the government hampered their response. Without testing, for example, industry groups argued nursing homes could not know who was infected so they could be isolated.
The chief nursing home trade group, the American Health Care Association, has lobbied strongly for federal subsidies to help nursing homes buy PPE such as face masks, gloves and disposable gowns. When the Department of Health and Human Services allocated $4.9 billion in aid to nursing homes on May 21, in part to pay for PPE, the AHCA said its members needed more.
Mark Parkinson, president and CEO of the association, said getting more help was vital. The association has sought a total of $10 billion in taxpayer assistance.
“The reality is that long-term care providers are facing an unprecedented situation that has left them begging for testing, personal protective equipment (PPE) and staffing resources,” he said in a statement. “Just like hospitals, we have called for help. In our case, it has been difficult to get anyone to listen.
“Whether it’s federal, state or local health agencies, long-term care needs to be a priority for supplies and help. It’s time that America rally around our long-term care residents just as they did with hospitals."
The trade group for nonprofit senior care, LeadingAge, also argues that more help is needed.
“Months into the crisis, it is pitiful that aging services providers are still scrounging for PPE. Too often, the only signs of FEMA’s much-hyped promise of PPE shipments — an allotment of gowns, gloves, masks and goggles based on staffing size of the provider — are scattershot delivery with varying amounts of rag-tag supplies,” Katie Smith Sloan, the group’s CEO, said in a statement Thursday.
While many patient advocates welcomed the additional data about the nursing home outbreaks, some warned against drawing quick conclusions because the picture it offers is incomplete.
“Nobody should be relying on the CMS data to get an accurate picture of the crisis unfolding in nursing homes across the country,” said Mike Dark, a lawyer with California Advocates for Nursing Home Reform. “Many facilities are still not reporting data, and spotty availability of testing kits and staff to administer the tests means that many sick residents and workers are not included in the counts.
“Until we get more accurate tallies it will be impossible for state and federal health authorities to know where resources are most needed. Many more of our elderly and disabled will die as a result.”
The CMS should have held nursing homes accountable for lapses in infection control and prevention long before the pandemic, said Arlene Germain, policy director of Massachusetts Advocates for Nursing Home Reform. Even as the coronavirus spread in March and April, nearly 600 nursing homes were cited by government inspectors for violating federal standards meant to prevent and control the spread of infections.
She said the deaths of more than 600 nursing home staff members could have been mitigated if homes were better prepared and had access to supplies and testing.
“It’s heartbreaking,” she said of the death count. “It shouldn’t have happened.”
Shawn Mulcahy contributed to this report.