Nursing home deaths spiked in 2020, watchdog report shows

Nursing home deaths spiked in 2020, watchdog report shows
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Deaths among Medicare beneficiaries in nursing homes increased last year by 32 percent compared to 2019, as the coronavirus ravaged vulnerable populations, according to a government watchdog report released Tuesday.

According to report from the Health and Human Services Office of Inspector General (OIG), 22.5 percent of all Medicare beneficiaries in nursing homes died in 2020, compared to 17 percent in 2019. That 32-percent increase amounts to 169,291 more deaths in 2020 than if the mortality rate had remained the same as in 2019. 

About 40 percent of all Medicare beneficiaries in nursing homes had or likely had COVID-19 — representing some 1.3 million people. 

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The report showed how the number of beneficiaries in nursing homes who had or likely had COVID-19 increased dramatically over the course of just a few weeks during the spring of 2020. In March, 492 Medicare beneficiaries in nursing homes per day were diagnosed as having or likely having COVID-19. 

By April, that number had increased almost tenfold, to an average of more than 4,700 new cases per day. 

The report examined "excess mortality," rather than individual causes of death. Excess deaths typically refer to the number of deaths from all causes during a crisis, above and beyond what would be expected under "normal" conditions. It's a common tool in public health that can provide information about the overall impact of the COVID-19 pandemic.

According to the report, each month of 2020 had a higher mortality rate than the corresponding month a year earlier. 

In April alone, a total of 81,484 Medicare beneficiaries in nursing homes died. This is almost 30,000 more deaths — an average of about 1,000 per day — compared to 2019. Medicare beneficiaries in nursing homes were almost twice as likely to die in April 2020 compared to April 2019.

But deaths spiked again in November and December. In November, about 5 percent of all Medicare beneficiaries in nursing homes died, and in December that increased to about 6 percent. 

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Nursing homes across the country essentially locked down in March, but health experts believe staff still unwittingly brought infections into the facilities, unleashing rapid outbreaks.

Nursing homes constantly said they did not have enough protective gear, or the ability to test every resident and staff member. The Trump administration recommended frequent testing, but did not mandate it. The responsibility was initially up to states, before the federal government belatedly got involved and allocated financial resources.

The report also found that while age and gender were not factors in increased mortality in nursing homes, race was. 

Asian Medicare beneficiaries in nursing homes had the greatest increase in mortality, with 27 percent dying in 2020 compared with 17 percent in 2019. The mortality rates for Hispanic beneficiaries in nursing homes and Black beneficiaries in nursing homes both hit 23 percent in 2020, up from 15 percent in 2019. 

The mortality rate of White beneficiaries also increased significantly, from 18 percent in 2019 to 24 percent in 2020, but it was not as pronounced.

Agency officials in the report said that data could play an integral part in understanding health disparities within the nursing home population and preparing for and dealing with future public health crises. 

The OIG report was one of the most comprehensive snapshots on the number of Medicare beneficiaries in nursing homes with COVID-19, because data were hard to come by, especially from early in the pandemic. Nursing homes are not required to report cases and deaths that occurred before May 8, 2020.