COVID-19 Mortality Rates Among Nursing Home Residents Declined From March To November 2020

Abstract

Improved therapeutics and supportive care in hospitals have helped reduce mortality from COVID-19. However, there is limited evidence as to whether nursing home residents, who account for a disproportionate share of COVID-19 deaths and are often managed conservatively in the nursing home instead of being admitted to the hospital, have experienced similar mortality reductions. In this study we examined changes in thirty-day mortality rates between March and November 2020 among 12,271 nursing home residents with COVID-19. We found that adjusted mortality rates significantly declined from a high of 20.9 percent in early April to 11.2 percent in early November. Mortality risk declined for residents with both symptomatic and asymptomatic infections and for residents with both high and low clinical complexity. The mechanisms driving these trends are not entirely understood, but they may include improved clinical management within nursing homes, improved personal protective equipment supply and use, and genetic changes in the virus.

Exhibit 3. Trends in daily and semimonthly crude 30-day COVID-19 mortality rates, by cognitive and functional status, among residents of a sample of US nursing homes, 2020

SOURCE Authors’ analysis of resident-level data from 282 nursing homes operated by a large, long-term care provider. NOTES Trend lines were estimated with locally weighted scatterplot smoothing, using all data points from the analytic sample (daily from March 16 through November 15). A scatterplot of unadjusted semimonthly mortality rates is superimposed. Cognitive Function Scale (CFS) scores range from 1 to 4; scores of 3 and 4 indicate advanced cognitive impairment. The Morris activities of daily living (ADL) score signifies the extent to which residents are dependent in seven activities of daily living, denoted by a higher score. An ADL score of 19 represents the seventy-fifth-percentile value of the analytic sample and reflects a substantial level of functional impairment.