Last week the Centers for Medicare and Medicaid Services released a study comparing Medicare beneficiaries in nursing homes (about 1.4 million of them) to those Medicare beneficiaries in the general community at large (60.6 million) between March and December of 2020. They were trying to see if there was a difference between the two groups in terms of becoming infected with COVID-19, hospitalized as a result, and then death from it.
One article about the story was titled “Medicare nursing home residents more likely to be diagnosed, hospitalized and die from COVID-19 than beneficiaries not in facilities.” Thank you, Captain Obvious. And surprisingly, this did not come from The New York Times.
The most alarming aspect of the story and reporting on it was that there was really no mention that all Medicare residents in nursing homes have some level of comorbidities, so of course, they are more susceptible to infection than healthy, or even healthier, Medicare beneficiaries living in the broad community. Otherwise, they would not be in the nursing home. The co-morbidities aspect is the reason why so many of our nursing home residents died from the infection. They were very frail to begin with. This is why we have maintained a certain percentage of nursing home deaths were not “from COVID,” but frail older people who died “with” COVID. In many cases, they were going to die from their other illnesses in days, weeks or months.
Nursing home residents account for about 2% of the Medicare population, but about 22% of all COVID cases in the time period studied. They were 14 times more likely to be diagnosed with COVID compared to beneficiaries in the community. They also represented 19% of all COVID hospitalizations and were 12 times more likely to be hospitalized than those Medicare beneficiaries in the community at large. There is no question that living in tight quarters, usually semi-private rooms, with asymptomatic staffers often bringing the infection into a building, was the cause of the high number of infections. But the hospitalizations and deaths had as much to do with their frail medical condition, if not more.
Regarding deaths, 43% of beneficiaries admitted to a hospital from a nursing home died, compared with 22% from the community. This also makes sense because those nursing home admits were already sick. The study did admit that it is “unclear what impact the lack of widespread testing early in the pandemic may have had on these case rates.” Helloooo, if the testing had been more available, with a 24-hour turnaround as opposed to the three days and up to a week that existed back them, the story would have very different, and the death rate all around would have been much lower.
The study did have some interesting breakdowns with regard to health issues of nursing home residents contributing to the outcomes, with end-stage renal disease being a bad one. It is clear that the senior care industry was not prepared for this kind of pandemic, with extremely high transmission rates, asymptomatic carriers and a difficult testing environment, but no one was prepared. Not state health departments, hospitals, labs and anyone else that could be involved. What is more interesting is that with the rapid spread of the Delta variant, with hospitalization rates hitting records in some areas, we are not hearing about rapid infection spread and deaths in nursing homes. Hmmm. Lesson learned? We hope, but you will never hear about it in the media.
