The NCSL Blog


By Samantha Scotti and Haley Nicholson

Residents and staff in long-term care facilities account for an estimated one-third of COVID-19 related deaths in the U.S., despite only 11% of cases occurring in these facilities. In a handful of states, this estimate is even higher, with residents accounting for over half the state’s fatalities.

A flag flies on the grounds of the Life Care Center nursing and rehabilitation facility in Elkhorn, Neb., where a large number of staff and residents tested positive for COVID-19. Nati Harnik/APBecause of the age and underlying health conditions among nursing home residents, they are particularly susceptible to severe illness or death caused by the coronavirus. Additionally, the congregate nature of the facilities and the close physical contact in which the staff work with the residents create an environment in which there is risk for the virus to spread.

Racial Disparities and COVID-19

Research shows racial disparities in how the coronavirus affects long-term care residents, not unlike the disparities seen in rates of infection and death among communities of color across the U.S. Recent research presented to the Senate Special Committee on Aging found that in nursing facilities there is “a strong and consistent relationship between race and the probability of COVID-19 cases and deaths.”

To prevent gaps from widening, Colorado recently created the COVID-19 Health Equity Response Team. This team works to collect data on COVID-19 and racial disparities and determine proactive measures to stop the spread among communities of color. Other states, including Michigan and New Jersey, are considering legislation to create task forces examining these racial disparities.

Social Isolation

To reduce residents’ risk of exposure, 46 states have issued guidance prohibiting or recommending prohibiting visitation in nursing facilities and three states have restricted visitation. While this step, paired with stricter social distancing measures inside the facilities, helps protect residents it can lead to residents experiencing isolation and loneliness.

To help facilitate connections among isolated older adults, Kentucky’s long-term care ombudsman is conducting well-check calls and purchasing technology equipment to help residents communicate with their family. In Massachusetts, the Executive Office of Elder Affairs and Joint Legislative Committee on Elder Affairs created a resource assisting state legislators to conduct wellness calls with constituents and provide basic information about local programs and resources.

Testing in Nursing Facilities

Testing of residents and staff is an important part of infection control to keep the virus out of and prevent spread in long-term care facilities. The Centers for Disease Control and Prevention (CDC) testing guidance for nursing homes includes various detailed measures, including:

  • Screening all health care personnel for fever and symptoms at the beginning of their shifts and testing those that screen positive.
  • Screening all residents for fever and symptoms each day and testing those that screen positive.
  • Testing all residents and health care personnel after a new confirmed case of COVID-19.
  • Implementing various follow-up testing measures to ensure the transmission has been terminated.

A handful of states, including Arizona, Delaware, New Jersey, New York, Pennsylvania, South Dakota, Texas and West Virginia, are creating plans for universal testing in nursing facilities for both residents and staff. While many of the measures above focus on symptomatic carriers, universal testing aims to reduce spread from asymptomatic carriers. 

The federal Coronavirus Aid, Relief and Economic Security Act (CARES Act) provided $200 million to the Centers for Medicare and Medicaid Services (CMS) to support additional infection control and conduct necessary survey and certification work related to COVID-19, including $80 million for states to increase inspections of nursing facilities. The CMS will allocate the funding based on performance-based metrics. Those facilities not completing 100% of focused infection control inspections by July 31 will be required to submit a corrective action plan outlining their strategy within 30 days.

Data and Reporting

Timely reporting of COVID-19 cases and deaths helps ensure resources can be directed effectively and active cases can be better isolated. In early May, CMS issued a final rule requiring nursing facilities to report COVID-19 data to the CDC and to make the data available to residents and their families. The first deadline for reporting data to the CDC was mid-May and approximately 80% of nursing facilities nationwide reported data. The most recent data is publicly available on the CMS website.

CMS has also worked with state partners to create a toolkit to help nursing facilities prevent the spread of COVID-19. The toolkit shares promising state practices for COVID-19 infection control including cleaning and disinfection standards, workforce and staffing, patient transfer and transportation needs, and others.

While data continues to emerge revealing the full impact of COVID-19 on long-term care facilities, states and the federal government are focusing on interventions to keep this population safe.

Samantha Scotti is a senior policy specialist in NCSL's Health Program.

Email Samantha

Haley Nicholson is senior policy director in NCSL's State-Federal Relations Division.

Email Haley

Posted in: Health, COVID-19
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About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.