COVID ‐19 Deaths in Long‐Term Care Facilities: A Critical Piece of the Pandemic Puzzle

Abstract

As of May 28, 2020, 26 states had 50% or more of their coronavirus disease 2019 (COVID-19) deaths occur in long-term care facilities (LTCFs), with Minnesota and Rhode Island at 81%, Connecticut at 71%, and New Hampshire at 70%. Among the 40 states providing LTCF death data (including Washington, DC), an average 43% of their total deaths occurred in LTCFs (n = 39,039) (Figure 1).1 The definition of LTCF differs by state but generally includes nursing home, group home, and intermediate care facilities. Some states more recently have included assisted living facilities. Despite such alarming reports, the remaining 11 states (Alabama, Alaska, Arizona, Arkansas, Hawaii, Michigan, Missouri, Montana, New Mexico, and North and South Dakota) still do not report their LTCF COVID-19 deaths. The lowest reported frequency of total deaths of 21%, reported by New York, is most certainly a gross underestimate in light of other northeastern state reports of LTCF death counts that are three to four times higher and where, during the surge, COVID-19–positive patients were transferred from New York2 and New Jersey hospitals to LTCFs. Further contributing to the underestimation of LTCF deaths is that in March and part of April, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing was largely unavailable to LTCFs and COVID-19 deaths were only counted as such if backed by a positive test.3 At the national level, the Centers for Disease Control and Prevention (CDC) relies on state as…