Nursing home deaths increased 32% last year amid pandemic

WASHINGTON – Deaths among Medicare patients in nursing homes soared 32% last year, with two devastating peaks eight months apart, a government watchdog reported in the review on Tuesday. more complete to date of the ravages of COVID-19 among its most vulnerable victims.

The Department of Health and Human Services Inspector General’s report found that about 4 in 10 Medicare beneficiaries in nursing homes had or likely had COVID-19 in 2020, and deaths in the ‘together jumped 169,291 from the previous year, before the coronavirus emerged.

“We knew it was going to be bad, but I don’t think even those of us working in this field thought it would be that bad,” said David Grabowski, professor of health policy at Harvard, a recognized expert. nationwide in long-term care, which reviewed the report for the Associated Press.

“These weren’t individuals who were going to die anyway,” Grabowski added. “We are talking about a huge number of excess deaths.”

Investigators used a generally accepted method to estimate “excess” deaths in a group of people after a calamitous event. This was not to look at the individual death certificates of Medicare patients, but to compare the overall deaths among people living in nursing homes to levels recorded the previous year. The technique was used to estimate deaths in Puerto Rico after Hurricane Maria in 2017 and in New York after the first wave of coronavirus last spring. It does not attribute a cause of death but is considered to be an impact barometer.

Death rates were higher every month last year compared to 2019. The report documented two spikes with particular implications for government policy and for protecting the most vulnerable during future outbreaks of deadly diseases. In April of last year, a total of 81,484 Medicare patients in nursing homes died. Then eight months later, after closings and frantic efforts to expand testing – but before vaccines were widely available – nursing home patients accounted for 74,299 deaths in December.

“This occurs long after it was clear that nursing homes were particularly vulnerable,” said Nancy Harrison, deputy regional inspector general who worked on the report. “You really have to watch this. Why have they remained so vulnerable? Federal investigators are still digging to try and document the chain of cause and effect.

In response to the report, the Centers for Medicare and Medicaid Services said nearly 80% of nursing home residents and more than 55% of staff are now vaccinated, and the agency is working to protect health and safety. security. CMS sets standards for nursing homes.

Tuesday’s report was the government’s most comprehensive yet as it included statistics for the first part of last year, during the first wave of coronavirus. Medicare did not require nursing homes to report COVID-19 cases and deaths before May 8, more than four months after the start of the pandemic year.

In another new finding, the report showed that cases and deaths among Asian American patients were tracked with the most severe impacts seen among blacks and Latinos. Indeed, people enrolled in Medicare in Asia in nursing homes saw the largest increase in death rates, with 27% deaths in 2020 compared to 17% the previous year. For whites, the death rate rose to 24% in 2020 from 18% in 2019, a significant increase but not as pronounced.

Death rates for Hispanic and black patients were 23% last year, up from 15% in 2019.

The Inspector General’s office based its analysis on Medicare billing data. It also included patients on Medicare Advantage plans sold by private insurers. Although Medicare does not cover long-term care, the vast majority of nursing home patients are seniors, and Medicare covers their medical needs. The report included both patients who live in nursing homes as well as those temporarily in a rehabilitation facility.

University of Chicago health economist Tamara Konetzka, who also reviewed the report for AP, said building an estimate from individual death certificates would have faced another set of challenges. Especially in the first wave of the pandemic, many people who died would not necessarily have been tested for COVID-19, for example.

“By looking at the excess deaths, you can step away from some of the measurement issues and say how much worse things were in 2020 than in 2019,” said Konetzka, who testified before Congress on the impact of the COVID-19 in nursing homes.

The Inspector General’s findings on Asians highlight a conundrum for researchers, Konetzka said. The reasons for the increase in cases and deaths among blacks, Hispanics and Asians are not necessarily related to race and ethnicity. Instead, minority patients can be grouped together in homes in communities where epidemics are more severe.

The report also found that patients in low-income nursing homes covered by Medicare and Medicaid together were much more likely to have contracted COVID-19. The infection rate for this group reached 56% and 26% died.

Some states have suffered the worst impacts. As of the end of December, more than half of Medicare patients in nursing homes in Connecticut, Illinois, Louisiana and New Jersey had or likely had COVID-19.

Across the United States, the coronavirus has found ideal conditions to spread among fragile patients in nursing homes living nearby. Many researchers believe it is likely that staff members unintentionally introduced the virus from surrounding communities.

Although the facilities were closed in March last year, government efforts to help have been hit and miss. The industry has complained of chronic shortages of protective equipment, including basic items like masks and gowns.

The Trump administration initially delegated responsibility for testing to states before belatedly mobilizing more federal resources. The HHS then laid the groundwork for vaccinations under the Trump administration, and the Biden administration followed through. As vaccination rates increased, nursing home cases dropped, allowing facilities to re-allow family visits.

The country cannot move forward yet, Deputy Inspector General Harrison said. “I hope COVID goes away,” she said. “But once that happens, there will always be infectious disease, and we all need to ask ourselves what we can do to protect vulnerable nursing home residents in the future. “

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