New Analysis Sheds Light on Covid Excess Mortality for Nursing Homes Vs. HCBS

Covid-19 mortality rates for younger residents in nursing homes were comparable to those in Medicaid home and community-based services (HCBS) from March 2020 through December 2020 – specifically HCBS recipients and nursing home residents 65 and younger.

That’s according to a study published in Health Affairs, among the first to provide multi-state data on mortality rates for Medicaid HCBS recipients. Excess mortality rates among these populations was 26.6 times that of the general population, the study found.

Younger HCBS recipients and nursing home residents saw about 150 more deaths per month than expected, per 100,000 people, according to the study.

The story is a little different for HCBS recipients and nursing home residents older than 65. This older HCBS population was just under 100 average deaths per month per 100,000 people, while average nursing home resident deaths were just over 1,000 per month per 100,000 people. To be clear, that’s about 100 and 1,000 more than expected mortality averages between March and December of 2020.

Such data didn’t come to light until recently, due to a lack of public reporting and timely data for Medicaid HCBS recipients, researchers said. Nursing homes, on the other hand, were linked to 23% of all Covid-related deaths in 2020 early on.

H. Stephen Kaye, University of California San Francisco, and Joseph Caldwell with Brandeis University in Waltham, Mass. partnered with the Long-Term Quality Alliance and health plans connected to the National Managed Long-Term Services and Supports Health Plan Association that agreed to share their data.

“Early in the Covid-19 pandemic, Congress required timely federal reporting on mortality in nursing homes. Ongoing studies have linked those reports to nursing home staffing, garnered media attention and helped inform critical policy discussions and responses,” Kaye and Caldwell wrote. “Unfortunately, similar reporting was not required for people receiving Medicaid HCBS.”

Medicaid HCBS represents about 7.5 million of those in need of long-term services and supports (LTSS) according to 2019 data, while nursing home residents make up about 1.6 million of this population, authors noted in the study.

Caldwell and Kaye said they hope their research shines a light on a population that has been for the most part “invisible” in public discourse and Covid response. While the pandemic elevated discussions concerning the need to reduce state reliance on nursing home care and in turn expand access to HCBS, “significant gaps” still remain in terms of access and availability in communities.

Factors that likely contributed to high mortality rates among HCBS recipients include individual risk factors, societal barriers and indirect impacts, according to the study.

“As aging and disability communities and policy makers work on systems reforms, our findings indicate a need to also address major gaps that exist in access to timely, publicly available data and quality reporting for people receiving HCBS across the age spectrum,” added Caldwell and Kaye in the study.