Nursing Facilities and the COVID-19 Pandemic

The COVID-19 pandemic took a significant toll on the health and well-being of older Americans, particularly those living in nursing facilities. The pandemic led to a 1% increase in deaths among individuals over age 65 in both 2020 and 2021 compared to predictions based on 2019 rates.

Medicare beneficiaries living in nursing homes were 14 times more likely to be diagnosed with COVID-19 than those living in the community.

COVID-19 deaths fell sharply after vaccine rollout, but there were disparities in vaccination rates. As of July 2021, 82% of residents and only 57% of nursing home staff were fully vaccinated. Increased risk of COVID-19 infection and unprecedented stress among nursing home staff were both factors in driving the current staffing shortages occurring in 24% of facilities nationally. Private nursing homes saw a 16% decline in staff, in spite of the fact that there was only a 10% decline in residents.

Black, Hispanic, and Native American Medicare beneficiaries in nursing homes also experienced higher COVID-19 case rates than White or Asian / Pacific Islander beneficiaries, suggesting that there are racial disparities in quality of care and facility oversight.

These alarming outcomes for nursing home residents put a spotlight on the need for parity of, if not increased, Medicaid funding and coverage for home-based vs. institutional care. Additionally, the devastating impact of the pandemic specifically on individuals in residential facilities underscores the urgent need for better quality monitoring and enforcement of accountability at these nursing facilities.

Lessons Learned and Policy Options

1. Congress could consider adopting reforms that would increase nursing home staffing, improve pay and working conditions for nursing home staff, and increase the number of full-time jobs. [Option 4.E.1]
2. Congress might consider requiring nursing home workers to be vaccinated for COVID-19 and other infectious diseases like the flu. [Option 4.E.2]
3. Congress might consider expanding the Medicare Graduate Medical Education (GME) programs to include nurse training. [Option 4.E.3]