The coronavirus pandemic has had an enormous impact on the U.S. over the past two years, causing nearly 1.1 million deaths. About 790,000 — over 75% — of those deaths were seniors over the age of 65. While only 2.5% of U.S. elders live in nursing homes, they account for over 20% of all senior deaths from COVID-19. Vaccines have drastically reduced coronavirus deaths, but seniors living in nursing homes remain a vulnerable population.
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According to our research team’s analysis of the latest available data:
Read further for breakdowns on case counts, differences in demographics, state-by-state comparisons, and more.
There have been 86,379,937 confirmed cases of COVID-19 in the U.S. as of July 2022, according to the Centers for Disease Control and Prevention (CDC). More than 1,065,091 people infected have lived in nursing homes, while an additional 1,129,161 have been nursing home employees or staff.
For accurate data, it’s important to differentiate nursing homes from the general category of long-term care facilities, a category that often also includes assisted living communities and skilled nursing facilities for people of all ages. Infection numbers in skilled nursing facilities greatly exceed those in nursing homes alone.
As of June 2022, 9,034,116 people over the age of 65 had contracted COVID-19, according to Statista. People in nursing homes — almost all over the age of 65 — made up over 11% of those deaths. Because nearly 50% of nursing home residents are 85 or older, the percentage of COVID-19 infections among that age demographic is likely even higher.
As of May 2021, approximately 54.1 million U.S. residents were 65 or older, according to the Administration for Community Living. About 1,347,600 — or 2.5% — of those seniors live in nursing homes.
That means 2.5% of seniors had 11% of all confirmed coronavirus cases. This percentage discrepancy shows the stark increase in COVID-19 infections between nursing home residents and members of the general public in a comparable age group.
The timeline of COVID-19 cases in nursing homes has generally mirrored that of the general U.S. population, with one key difference.
Infections first peaked in the final week of December 2021, before vaccines were widely available, with over 33,600 cases reported in U.S. nursing homes. The second infection peak occurred in the third week of January 2022, during the spread of the Omicron variant. Over 49,000 cases were reported that week — however, it’s worth noting that, while deaths also rose during that time, those numbers remained far lower than pre-vaccine statistics.
While these trends mirror those of the U.S. as a whole, there’s also an additional spike in nursing home infections in the early months of 2020, before many facilities — communal settings with high transmission rates — were prepared and equipped to deal with the virus.
Nursing home and long-term care facility infections vary greatly by state. Because data is provided by individual states, which often have their own databases and methodologies for tracking cases in long-term care facilities, numbers may not be reliable across the board.
In general, nursing home COVID-19 infection numbers were higher in areas with higher case numbers among the general population. It’s worth noting that case numbers varied geographically over time, as well. While some states had large outbreaks early in the pandemic that were well-controlled with the widespread availability of vaccines, other states’ infection rates peaked later in the pandemic — generally in areas where vaccination is less common.
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Over 153,200 nursing home residents have died of COVID-19 since the start of the pandemic, according to the Centers for Medicare and Medicaid Services (CMS). This figure only includes deaths attributed directly to the coronavirus — the toll would likely be much higher if post-COVID complications were included.
Over 200,000 — or 20% — of COVID-19 deaths have occurred in long-term care facilities, which include assisted living communities as well as nursing homes, according to the Kaiser Family Foundation. While many more people reside in assisted living communities, over two-thirds of long-term-care-facility deaths occurred in nursing homes, residents of which are often in overall worse health than their assisted living counterparts.
As of June 2022, 748,084 people over the age of 65 had died of COVID-19, according to Statista. People in nursing homes — almost all over the age of 65 — made up over 20% of those deaths. Since nearly 50% of nursing home residents are 85 or older, the percentage of COVID-19 deaths among that age demographic is likely even higher.
Nursing home deaths from COVID-19 spiked mid-pandemic before vaccines were widely available. However, death rates are still elevated in this population demographic.
Nursing home deaths peaked in December 2020 and January 2021, with nearly 6,000 residents dying each week, according to the CDC. Post-vaccine, that number dropped sharply, with under 1,000 nursing home residents dying each week between March 2021 and early January 2022.
As the Delta and Omicron variants emerged, deaths increased, with numbers rising above 1,000 deaths a week in January 2022 — the highest fatality rate in over 10 months.
Now, death rates have stabilized but continue to exceed those of the general population. In June 2022, more than 150 nursing home residents died of COVID-19 each week.
Nursing home and long-term care facility deaths vary greatly by state. Data isn’t always reliable, as states perform individual tracking and often have separate databases and methodologies. However, the CDC and COVID Tracking Project offer a general breakdown of week-by-week deaths divided by state.
Excess mortality is the difference between the number of people who would normally die during a certain time frame measured against the number of people who have died during a specific outbreak or pandemic. Research funded by the Bill and Melinda Gates Foundation suggests that, by looking at excess mortality, we can deduce that the impact of the COVID-19 pandemic is far greater than the number of deaths directly attributed to the coronavirus.
A study conducted by researchers at Brown University and published in the journal Geriatrics specifically looked at excess mortality in long-term care facilities by comparing data sets from 2018 and 2019 to comparable numbers from 2020 and 2021.
During that period, assisted living residents experienced 17% higher mortality, while nursing home residents had over 24% excess mortality. This difference exceeds the number of deaths attributed directly to the COVID-19 pandemic.
There are several potential reasons for this discrepancy:
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Nursing home residents are one of the most vulnerable demographic groups in the U.S. They’re also one of the most highly vaccinated.
As of June 2022, 87.8% of residents had received at least one dose of the COVID-19 vaccine and 81.9% had received booster doses, according to the Centers for Medicare and Medicaid Services.
As stated above, almost half of nursing home residents are over the age of 85, and less than 15% are under the age of 65, according to the National Center for Health Statistics.
We can compare general population vaccine status to the status of nursing home residents by examining trends within those age groups. Over 95% of seniors over the age of 75 have received at least one dose of the COVID-19 vaccine, and 88% have received booster shots. Data for those aged 65-74 is similar, with a slight increase in booster doses.
Why are vaccination rates lower among nursing home residents than general populations in the same age demographic when their risk level is higher? Comprehensive research published by Brookings postulates several reasons:
Vaccination rates vary greatly from state to state. In Arizona, Texas, and Nevada, less than 72% of nursing home residents are fully vaccinated. Massachusetts boasts a vaccination rate of just under 92%. Surprisingly, South Dakota has one of the highest nursing home resident vaccination rates in the country, despite a lower vaccination rate in the general public.
See rates of vaccination between nursing home and non-nursing home populations below.
Though residents are protected by their vaccines, staff vaccination rates offer an additional level of protection — one which can be vital to seniors with comorbidities and health concerns.
According to June 2022 data published by the Centers for Medicare and Medicaid Services, 87.1% of nursing home employees had received at least one dose of the COVID-19 vaccine. However, only 52.8% had been fully vaccinated with a booster dose.
This percentage varied widely by both state and facility. In Massachusetts, 96.9% of nursing home staff members had been fully vaccinated. That number plummeted in more rural, Southern states, with less than 35% of nursing home employees in Louisiana and Mississippi receiving complete vaccine regimens.
As stated above, vaccination status fluctuated greatly from state to state. Unsurprisingly, regional variation in nursing home staff vaccination often mirrored the vaccination status of general populations on a state-by-state basis, according to CMS data visualizations.
The people who work at nursing homes are, on average, fairly young. In 2018, 28% of workers were younger than 30, and an additional 37% were between the ages of 30 and 49, according to Argentum’s publication Senior Living Labor and Workforce and Trends.
At that time, projections indicated that the long-term care workforce would age significantly by 2024 — however, trends have proven the opposite. In 2021, 57% of employees at Benchmark Senior Living — a prominent provider — were between the ages of 20 and 30, with less than 15% over the age of 40. A likely cause of this trend reversal is the COVID-19 pandemic, which may have pushed workers with age-related risk factors out of positions in long-term care settings.
No data currently exists on vaccination status by age in the nursing home workforce, but because the majority of nursing home employees are aged 20-40, we can compare the vaccine status of that cross-section of the population with the vaccine status of long-term care employees in general.
As of June 2022, 63.9% of U.S. residents aged 18-24 had received a completed vaccine regimen. 67.2% of people aged 25-39 had as well, according to the CDC’s most recent COVID-19 Vaccination and Case Trends by Age Group data set.
Because only 52.8% of nursing home employees were fully vaccinated, we can deduce that, despite working in a high-risk COVID-19 environment, people working at nursing homes are less likely to be fully vaccinated than members of the general public in a similar age demographic.
A case study published in The New England Journal of Medicine indicated that if nursing home staff nationwide had been vaccinated when doses were first available, up to 12,276 cases and 703 deaths may have been prevented.
While statistics vary from source to source depending on the inclusion of long-term care facility type, we can use the Centers for Medicare and Medicaid Services as a guideline for recovery percentages.
Of the 1,065,091 total confirmed COVID-19 cases among nursing home residents, 153,201 resulted in death. From those numbers, we can calculate an 87.5% recovery rate from COVID-19.
Across the general U.S. population, recovery numbers are far higher than those seen in nursing homes or long-term care facilities. According to the CDC’s most recent data, 1,009,444 people in the U.S. have died of COVID-19, compared to a total of 86,379,937 confirmed cases. That recovery rate is over 98%. It is greatly influenced by the number of young people infected with mild cases of COVID-19.
It’s well-known that certain population groups have been more heavily affected by the COVID-19 pandemic, including Black, Indigenous, and Hispanic communities, lower-income communities, and people living in densely populated areas.
Overall, COVID-19 has taken a much higher toll on communities of color. Black, Hispanic, and American Indian and Alaska Native (AIAN) populations have experienced higher death and infection rates than the general U.S. population. However, the Center for Medicare and Medicaid Services does not require nursing facilities to report race/ethnicity data for COVID-19 cases and deaths. For this reason, it’s not possible to fully document the impact of race on nursing home coronavirus cases or deaths.
That said, facilities with high percentages of Black or Hispanic residents were more likely to have high infection rates, according to the Kaiser Family Foundation, indicating the impact of the virus on Black, Indigenous, and Hispanic communities in nursing homes.
While wealthier and middle-class Americans are more likely to choose assisted living or home care services as they age, many people who rely on Medicaid and can’t afford private-pay facilities often end up living in state-owned nursing homes.
While there isn’t specific data available on individual resident income, COVID-19 deaths have been higher in underfunded and state-owned nursing homes often occupied by lower-income seniors, according to the Administration for Community Living.
Areas with higher population density were more likely to experience elevated COVID-19 infections. The same holds true for nursing home residents. Those in larger cities with densely populated facilities were more likely to both contract and die from COVID-19, according to The New England Journal of Medicine.
Before vaccines were widely available, politics had little effect on COVID-19 cases and deaths in nursing homes. However, once vaccines became widely available, hesitancy to receive shots did impact case and death statistics. Vaccine hesitancy is often influenced by party association, with more conservative adults refusing vaccination, according to The New York Times.
Brookings postulates that while political party affiliation is less likely to affect members of high-risk populations’ decision to be vaccinated, it is likely to influence nursing home employees and staff.
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