Deaths in U.S. nursing homes will increase 32% by 2020, the Government Guard says

(WASHINGTON) – Deaths among Medicare patients in nursing homes have risen by 32% last year, with two devastating peaks eight months apart, a government watchdog reported Tuesday in the most comprehensive look of the devastation of COVID-19 among its most vulnerable victims.

– “We knew it was going to be bad, but I don’t think even those of us who work in this area thought it was going to be so bad,” said David Grabowski, a professor of health policy at Harvard, a nationally recognized expert on long-term care, which reviewed the report for The Associated Press.
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“It wasn’t the individuals who were going to die though,” Grabowski adds. “We’re talking about a really large number of excesses of death.”

The researchers used a generally estimated method of estimating “Excess” deaths in a group of people after a calamitous event. It did not involve examining the individual death certificates of Medicare patients, but comparing deaths in general among those in nursing homes by the 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 coronaviruses last spring. He does not attribute a cause of death, but is seen as an impact barometer.

Mortality rates have been higher in each month of last year compared to 2019. The report documented two spikes with particular implications for government policy and to protect the most vulnerable in future outbreaks of disease-threatening diseases. life. In April last year, a total of 81,484 Medicare patients in nursing homes died. Eight months later, after closures and frantic efforts to extend trials – but before vaccines became widely available – patients in nursing homes suffered a disaster of 74,299 deaths in December.

“This happened long after it was clear that nursing homes were particularly vulnerable,” said Nancy Harrison, deputy regional inspector general who worked on the report. “We really have to look at that. Why are they so vulnerable?” Federal investigators are still furious to try to document the chain of causes and effects.

Tuesday’s report was the most comprehensive by the government because it included statistics for the first half of last year, during the initial growth of coronavirus. Medicare does not need rest homes to report COVID-19 cases and deaths that occurred before May 8, more than four months into the pandemic year.

In another new finding, the report showed that cases and deaths among Asian American patients were traced with the most severe impacts seen among Blacks and Latinos. In fact, Asian Medicare workers in nursing homes have seen the highest increase in mortality rates, with 27% dying in 2020 compared to 17% the previous year. For whites, the death rate has increased to 24% in 2020 from 18% in 2019, a significant but not so pronounced increase.

Mortality 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, including patients on Medicare Advantage plans sold by private insurers. Medicare covers the vast majority of patients in nursing homes, and the report included long-term residents as well as those temporarily in a rehabilitation care facility.

Health economist Tamara Konetzka of the University of Chicago, who also reviewed the report for AP, said building an estimate from individual death certificates would have faced another set of challenges. Particularly in the first wave of the pandemic, many who died did not need to be tested for COVID-19, for example.

“Looking at the excess deaths can take us away from some of the measurement problems and tell us how bad things were in 2020 than in 2019,” explains Konetzka, who told Congress about the impact of COVID. -19 in nursing homes.

Konetzka said the inspector general’s findings on Asians highlight a riddle for researchers. The reasons for higher cases and deaths among Blacks, Latinos and Asians cannot necessarily be linked to race and ethnicity. However, minority patients can be grouped into homes located in communities with more severe outbreaks.

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

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

In the United States, coronavirus has found ideal conditions to spread among fragile nursing home patients living in cramped neighborhoods. Many researchers believe the likely staffers carried the virus from surrounding communities.

Although the structures were closed in March last year, the government’s efforts to help have been futile. The industry has complained of chronic shortages of protective gear, including basics such as masks and clothing.

The Trump administration initially delegated responsibility for the tests to states before belatedly pooling more federal resources. HHS laid the groundwork for vaccination under the Trump administration, and the Biden administration followed suit. As vaccination rates increased, the number of nursing homes fell, allowing facilities to also allow family visits.

The country cannot even move forward, Deputy Inspector General Harrison said. “Hopefully COVID will leave,” he said. “But once that happens, there will always be infectious diseases, and we must all ask ourselves what we can do to protect the residents of vulnerable nursing homes going forward.”