Nothing Much Has Changed: COVID‐19 Nursing Home Cases and Deaths Follow Fall Surges

Journal of the American Geriatrics Society

Fecha de publicación: 12 November 2020


Autores: R. Tamara Konetzka PhD, Rebecca J. Gorges PhD

Background: In spring 2020, as the COVID‐19 pandemic took hold in the United States, nursing home deaths accumulated rapidly, accounting for more than 40% of deaths nationally by June. Referred to as a “perfect storm” of risk factors, nursing homes house, in close quarters, large numbers of older adults with underlying health conditions who need hours of hands‐on care daily. The combination of these features with the virus’s asymptomatic spread presented a crisis to even the highest‐quality nursing homes. Community spread of the virus was the biggest risk factor for nursing home cases and deaths, with apparently little that nursing homes could do to prevent outbreaks.

Several months into the pandemic, best practices emerged: (1) test staff regularly, using rapid‐results testing; (2) test residents regularly, especially once a case is detected; (3) separate COVID‐positive from COVID‐negative residents, ideally with dedicated staff for each group; (4) ensure staff use of personal protective equipment (PPE); and (5) employ standard sanitation procedures. Although the Centers for Disease Control (CDC) and the Centers for Medicare and Medicaid Services (CMS) issued guidelines consistent with these best practices, policymakers offered little assistance with securing supply chains for PPE and testing, technical assistance, or ensuring sufficient staffing. In summer 2020, in an implicit acknowledgement that nursing homes and states could not solve the supply chain issues on their own, CMS began shipping limited quantities of PPE and testing supplies to nursing homes.

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