REPORT BY NICOLE ASCHOFF AND PANKAJ MEHTA
Why did Massachusetts’s nursing homes fail so profoundly? And how can we prevent this from happening again?
A fog of uncertainty surrounds the SARS-CoV-2 virus that has wreaked havoc on families and communities worldwide over the past six months. No scientific consensus has been reached on the epidemiological characteristics of the disease. Scientists disagree on the detailed biological mechanisms underlying coronavirus transmission and acquired immunity. At the same time, public health officials are unsure how to contain the virus, while politicians are at odds over how to mitigate the economic and social fallout the pandemic has left in its wake.
But one thing is certain: The lethality of COVID-19 increases dramatically with age. Nationwide, according to Aug 1 data from the Centers for Disease Control, roughly eight out of 10 people who have succumbed to the virus are over the age of 65, while people under the age of 25 accounted for 0.2% of total COVID-19 deaths.
The picture is similar in Massachusetts, where at the time of this writing, no one under the age of 19 has died of COVID-19. Of the 8,691 COVID-19 deaths reported on Aug 6, 1.7% were adults under 50. Deaths for adults between the ages of 50 and 59, and 60 and 69, were 3.6% and 10.3% respectively. Bay State residents between 70 and 79 accounted for 21.7% of deaths, while those over the age of 80 made up 62.7% of all COVID deaths. The average age of death in total Mass COVID-19 cases was 82 years old.
Even more striking than the age-skewed mortality of the virus is the concentration of its deadly toll. According to the Foundation for Research on Equal Opportunity, approximately 45% of all US COVID-19 deaths were residents in assisted living facilities and long-term care facilities (LTCFs)—facilities such as nursing homes, rest homes, and skilled nursing facilities that provide residents, who are primarily elderly, with long-term rehabilitative care or skilled nursing care to meet the needs of daily life.
In some states, the concentration was overwhelming. New Hampshire and Minnesota have seen 80% of their COVID-19 deaths happen in LTCFs or assisted living facilities, with 70% in Ohio and 60% in Pennsylvania. In the Commonwealth, more than six out of 10 deaths occurred in LTCFs. Long-term care facility deaths accounted for the majority of COVID-19 deaths in nearly every county in the state.
We analyzed data on COVID-19 deaths at long-term care facilities in Mass over an approximately three-month period ending in mid-June by combining official LTCF death statistics from the Massachusetts Department of Public Health with census data, datasets on health disparities, facility-level data on race and ethnicity, official Medicare provider data, newly collected pricing data, and data on the state’s isolation unit policy. The key findings in our report:
- Nursing homes across the state suffered extremely high death rates during the coronavirus pandemic—at least 51 nursing homes in the state saw 20% or more of their residents die from COVID-19.
- In many nursing homes, COVID-19 deaths were 10, 15, or 20 times greater than the COVID-19 death rate (approximately 1.8%) for all Mass residents aged 80 to 89, as of June 17.
- LTCFs that created isolation units to care for COVID-19 positive patients from hospitals, acute care centers, and elsewhere in exchange for supplemental payments from MassHealth suffered higher death rates than homes that did not establish isolation units. The isolation unit policy remains in place, making it essential to investigate why these LTCFs had higher death rates.
- Federal scores for LTCF quality, staffing, and safety assigned prior to the pandemic were inaccurate predictors of resilience. Highly rated homes proved unable to keep their residents safe from the coronavirus, calling into question the validity and usefulness of these scores.
The stark and inescapable conclusion is that the coronavirus pandemic overwhelmed long-term care facilities, revealing a care system unable to keep elderly residents safe.
The battle to quell the pandemic is far from over. Scientists say that the coronavirus, like HIV and influenza, could linger, causing death and disruption until a vaccine is developed or the population reaches herd immunity. Moreover, infectious disease experts say coronaviruses and other infectious diseases with the potential to become pandemics are on the rise globally.
It is essential to understand why nursing homes in Mass were unable to keep their residents safe so that, moving forward, we can develop a plan to protect our state’s most vulnerable residents.
About the authors:
Nicole Aschoff is the managing editor of the Boston Institute for Nonprofit Journalism. She holds a PhD in sociology from the Johns Hopkins University and is the author of The Smartphone Society: Technology, Power, and Resistance in the New Gilded Age.
Pankaj Mehta is an associate professor of physics and a founding member of the College of Data Science at Boston University. He is also a member of the Boston chapter of Science for the People.