COVID-19 Nursing Home Resident and Staff Deaths – AARP

Most data are from analysis of data are from the Centers for Medicare & Medicaid Services (CMS) Nursing Home COVID-19 Public File (downloaded most recently on 12/8/2023). These data are self-reported by facilities to the Centers for Disease Control and Prevention (CDC) weekly.

Vaccine data for Q4 2023 are from the CDC Nursing Home COVID-19 Vaccination Data Dashboard (https://www.cdc.gov/nhsn/covid19/ltc-vaccination-dashboard.html; accessed 12/8/2023).

Several data points in the state fact sheets include general population state data (that is, not limited to nursing homes) as a denominator or stand-alone measure. These data are from CDC (downloaded most recently on 12/6/2023).

Data were analyzed by Scripps Gerontology Center at Miami University in Ohio, additional analysis and preparation of the dashboard by the AARP Public Policy Institute.

Key Definitions

CDC has issued detailed instructions to nursing homes for reporting these data:

Inclusion Criteria

For the four-week measures, nursing homes were included only if the facility reported to CDC for all four weeks (nationally, 98% of facilities for the most recent four-week period, for states ranging from 94% to 100%). If a nursing facility reported but had missing data for a specific measure, that facility is excluded from the calculation of that measure for the dashboard.

Most nursing facilities with missing data are only missing the most recent week (ending 11/19/2023). That is, most missing data are due to late responses, not skipped entirely. To have the most current data possible, we must exclude those facilities that were late in reporting the most recent week of data as well as those with one or more weeks of non-response in earlier weeks.

Vaccination data points are based on the most current week of data for each facility, as long as it is within the last four weeks. Facilities do not need to report for all four weeks to be included. The Dashboards use of multiple weeks of data and definition of booster rate and up to date rate as a percentage of all residents/staff means that rates may be systematically different than what is reported elsewhere.

Aggregate counts of deaths and cases may be an undercount if there are facilities that are not reporting. Percentages or rates might be slightly biased if the average of non-reporting facilities differs significantly from the average of reporting facilities.

For the measures of cases and deaths since 6/1/2020 and since January 2020, all nursing homes reporting at least one week of data are included. The national response rate is typically greater than 99% for both measures.

Comparability to Other Data Sources

The first reporting date for the CMS Nursing Home COVID-19 data was May 24, 2020, and includes all cases and deaths that were reported since the beginning of the year; however, retroactive reporting is not mandatory, and the accuracy of reporting at the state level is unknown. Vaccination data were first reported for the week ending May 30, 2021, and are mandated as of the week ending June 13, 2021.

Data points that go back prior to the first reporting date, including the since January 2020 counts of resident cases and deaths in the state fact sheets, may significantly undercount the total number of cases and deaths. At the national level, the CMS data source gives a significant undercount of the number of cases and deaths before June 2020, compared to other sources that were reporting in real-time.

Since June 2020, the CMS data are much more reliable and at the national level track well against data reported by the states (comparisons to individual states are difficult because each state categorizes and reports the data differently).

The state fact sheets include several measures of the percentage of total state deaths and cases that occurred among nursing home residents and nursing home staff. Because the denominator data is from a different source, the reported data may result in a percentage less than 0% or greater than 100%, which is impossible. The value of each such measure is capped at 100%, and values of less than 0% are marked as NA. These measures should not be used to compute the number of cases or deaths occurring outside of nursing homes.

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COVID-19 Nursing Home Resident and Staff Deaths - AARP