COVID Outbreaks in Nursing Homes Accelerate Premature Deaths from Other Causes

The COVID-19 pandemic has led to a significant increase in nursing home deaths caused by other factors, a new analysis performed on behalf of the Associated Press has determined.

Every two coronavirus deaths in nursing homes were associated with an additional premature death for another reason, University of California, San Francisco professor Stephen Kaye determined based on data from 15,000 nursing homes recorded since March.

Kaye concluded that the strain on the nursing home workforce could have been a major contributing factor: Persistently short-staffed even before a global pandemic, facilities stretched dangerously thin by the novel coronavirus may not have been able to effectively focus on the needs of non-COVID patients.

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“The health care system operates kind of on the edge, just on the margin, so that if there’s a crisis, we can’t cope,” Kaye told the news organization. “There are not enough people to look after the nursing home residents.”

Kaye’s study estimated the number of “excess deaths” at U.S. nursing homes since March at more than 40,000, or 15% higher than the expected rate, the AP reported.

More than 65,000 long-term care facility residents have died of COVID-19 through the first week of November, according to the official tally from the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control & Prevention (CDC); that number is almost certainly an undercount, as the federal government was only able to mandate data collection starting in May.

The AP examined increases in cases of reported abuse and neglect, as well as “seemingly banal” problems caused by strict shutdown rules that prevented routine access by both family members and specialty physicians: Without access to a dentist, for example, a resident with denture problems could soon spiral into malnutrition.

“I don’t think anyone really understood how much time friends and family, volunteers and other people spent in the nursing home and supplemented that hands-on care,” Connecticut long-term care ombudsman Mairead Painter told the outlet.

The analysis comes as nursing homes reported their highest weekly COVID-19 case counts since the start of data collection in May, with industry leaders pleading for the public to take steps to reduce the spread of the virus in the wider community — a top predictor of outbreak risk at long-term care facilities, along with proper staffing levels.

“Our worst fears have come true as COVID runs rampant among the general population, and long-term care facilities are powerless to fully prevent it from entering due to its asymptomatic and pre-symptomatic spread,” American Health Care Association CEO Mark Parkinson said in a statement.

CMS this week also advised operators to exercise extreme caution during the impending holiday season, discouraging families from taking their loved ones out of facilities for gatherings and emphasizing that its rules around visitations will not change for Thanksgiving and Christmas.

“We think our visitation guidance is sound, and allows for the appropriate way to conduct visitation when there are or are not cases,” CMS nursing home division director Evan Shulman said earlier this week. “As you all know, the virus does not take off for the holidays. We need to be just as vigilant … This is no time to back off.”