Why Nursing Homes Are Covid Hot Spots

Nursing homes account for a disproportionate share of Covid-19 cases and deaths. Covid outbreaks continue to plague nursing homes despite visitor restrictions that began in mid-March. Why are nursing homes such hot spots? A National Bureau of Economic Research study may have the answer: staff linkages.

In a unique study, NBER researchers analyzed the geolocation data of more than 500,000 smartphones observed in at least one of 15,000 nursing homes during the six weeks following the nationwide nursing home visitor restrictions that went into effect March 13. Since visitors were no longer allowed into nursing homes, most of these smartphones belonged to staff. The goal of the study was to discover how interconnected nursing homes are through their staff. Very connected: "We find that 7 percent of individuals entering a nursing home also entered at least one other nursing home in the six-week period," the researchers report. The average nursing home, in fact, has connections with 15 other nursing homes. There are a number of reasons for this high level of connectivity. One, most nursing homes rely on staffing agencies to fill some of their staffing needs, which can vary from day to day. Two, nursing home workers may work at multiple facilities and many do. Three, hospice workers and other specialists travel to multiple nursing homes.

"Eliminating staff linkages between nursing homes could reduce Covid-19 infections in nursing homes by 44 percent," the researchers estimate. "These results provide evidence of the magnitude of the benefits that would derive from compensating nursing home workers to work at only one home and limiting cross-traffic across homes," they conclude.

Source: National Bureau of Economic Research, Nursing Home Staff Networks and Covid-19, Working Paper #27608

Characteristics of Nursing Home Residents

More than 1.3 million Americans lived in the nation's 15,600 nursing homes in 2015–16, according to the National Center for Health Statistics' National Study of Long-Term Care Providers. Despite the aging of the population, the nursing home population is shrinking. There were a larger 1.5 million nursing home residents in 2000 compared to the 1.3 million counted by the latest survey. Here are the characteristics of nursing home residents in 2015–16...

• 65 percent are women
• 84 percent are aged 65 or older, and 65 percent are aged 75 or older
• 75 percent are non-Hispanic White, 14 percent Black, and just 5 percent Hispanic
• 48 percent have been diagnosed with Alzheimer's disease or another dementia
• 60 percent need help eating, 87 percent need help transferring in and out of a chair or bed, 89 percent need help toileting, and more than 90 percent need help bathing, dressing, and walking
• 62 percent are dependent on Medicaid to pay their nursing home costs

Source: National Center for Health Statistics, Long-Term Care Providers and Services Users in the United States, 2015–2016

How Many Have Dementia?

Half of nursing home residents have Alzheimer's or dementia, according to a government report on long-term care. But most people with dementia live in their community. Overall, 10 percent of Medicare beneficiaries aged 65 or older who are not living in a nursing home have dementia. Here are the percentages by age...

Percent with dementia*
Aged 65 to 69: 3.6%
Aged 70 to 74: 4.8%
Aged 75 to 79: 9.9%
Aged 80 to 84: 15.3%
Aged 85 to 89: 24.0%
Aged 90-plus: 36.2%

* Among non-nursing home population
Source: Federal Interagency Forum on Aging-Related Statistics, Older Americans 2016: Key Indicators of Well-Being

Decline in Nursing Home Residents

The number of nursing home residents has fallen steadily since 1997 as home health care and residential care options have expanded. Between 1997 and 2014, the number of nursing home residents fell 9 percent—despite a 26 percent increase in the 65-plus population and a 57 percent increase in the number of people aged 85-plus.

Fewer nursing home residents
2014: 1,369,000
2010: 1,396,000
2005: 1,436,000
2000: 1,480,000
1997: 1,503,000

Source: National Center for Health Statistics, Long-Term Care Providers and Services Users in the United States: Data from the National Study of Long-Term Care Providers, 2013-2014, and Health United States, 2015