In my last post, I briefly touched on COVID-19 and older adults. In this post, I will take a short, basic data tour of the skilled nursing home COVID-19 data made available by the CDC.
COVID-19 and Nursing Homes
Late February, in Washington state, Stat News reported the first COVID-19 death in a nursing facility, along with a first alleged outbreak. 1 In the middle of March, the Center for Medicare and Medicaid Services (CMS) announced measures to be taken in order to keep those in nursing facilities safe amid the pandemic. 2 But just a few weeks later, Kaiser Health News (KHN) wrote about nursing patients being caught up between homes and hospitals.3 By April, multiple states took matters into their own hands and devised their own plans to protect people in nursing homes.4
Unfortunately for most people in nursing facilities, the damage was done. By then there were more than 10,000 reported COVID-19 related deaths stemming from nursing homes.5 In May, HHS committed billions to skilled nursing homes in a late attempt to mitigate the effects COVID-19 had on them.6 CMS also began requiring homes to submit data to the CDC.
COVID-19 Data and Nursing Homes
What if the data is incomplete, or arguably worse, the data is wrong? If you go to CMS’ website you can download the nursing home data. Unfortunately, it only goes back to the last week in May. Months of data, missing — or aggregated into one week.
Straight from CMS’ website:
Facilities may opt to report cumulative data retrospectively back to January 1, 2020. Therefore, some facilities may be reporting higher numbers of cases/deaths compared to other facilities, due to their retrospective reporting.
That is exactly what happened. Multiple facilities front-loaded their cumulative cases and deaths in the last week of May. The weeks after begin to paint a more accurate picture; as the nursing home teams have become more comfortable with the reporting process, their data are more in line with what is happening at their facility.
|Week Ending||Sum of Residents Weekly Confirmed COVID -19||Sum of Residents Weekly COVID-19 Deaths|
Looking at the data (pulled August 17), It appears the number of confirmed resident cases and deaths for the week of May 24 is much higher than the following weeks. (Disclaimer: I used a pivot table and only took the numbers labeled as passing the QA check. The total numbers were even higher.)
If you look closer, you can see what happened, and what was probably expected. Take Belmont Manor Nursing Home, out of Massachusetts, for example.7 It’s recorded that they had 49 COVID-19 deaths the week of May 24th and 71 confirmed cases. In the weeks after that, they had several more confirmed cases, but no more deaths. The likelihood of all deaths happening in one week is fairly slim. More likely is that they’re one of the organizations that reported all previous cases and deaths in that first week.
|Provider Name||Week Ending||Residents Weekly Suspected COVID-19||Residents
Weekly Confirmed COVID-19
|Residents Weekly COVID-19 Deaths||Residents Weekly All Deaths|
|Belmont Manor Nursing Home||5/24/20||71||71||49||56|
|Belmont Manor Nursing Home||5/31/20||0||0||0||0|
|Belmont Manor Nursing Home||6/7/20||1||0||0||0|
|Belmont Manor Nursing Home||6/14/20||1||0||0||0|
|Belmont Manor Nursing Home||6/21/20||0||2||0||0|
|Belmont Manor Nursing Home||6/28/20||0||0||0||0|
|Belmont Manor Nursing Home||7/5/20||0||2||0||0|
|Belmont Manor Nursing Home||7/12/20||0||0||0||0|
|Belmont Manor Nursing Home||7/19/20||0||0||0||0|
|Belmont Manor Nursing Home||7/26/20||0||0||0||0|
|Belmont Manor Nursing Home||8/2/20||0||0||0||0|
Another example is the Erwin Health Care Center. They have 16 deaths recorded for the last week in May and only a few more in the following weeks. I’m thinking Erwin reported all prior data for the week of 5/24/2020 as well. They also reported zero confirmed COVID-19 cases any of the weeks. Perhaps these deaths were not COVID-19 related.
|Provider Name||Week Ending||Residents Weekly Suspected COVID-19||Residents Weekly Confirmed COVID-19||Residents Weekly COVID-19 Deaths||Residents Weekly All Deaths|
|Erwin Health Care Center||5/24/20||0||0||0||16|
|Erwin Health Care Center||5/31/20||0||0||0||0|
|Erwin Health Care Center||6/7/20||0||0||0||0|
|Erwin Health Care Center||6/14/20||0||0||0||0|
|Erwin Health Care Center||6/21/20||0||0||0||0|
|Erwin Health Care Center||6/28/20||0||0||0||1|
|Erwin Health Care Center||7/5/20||0||0||0||0|
|Erwin Health Care Center||7/12/20||0||0||0||3|
|Erwin Health Care Center||7/19/20||0||0||0||2|
|Erwin Health Care Center||7/26/20||0||0||0||0|
|Erwin Health Care Center||8/2/20||0||0||0||0|
There are numerous nursing homes that had a plethora of confirmed cases and deaths the last week in May, only to add a few more cases throughout the rest of the summer. CMS mentioned that could happen. Granted, there also could have been multiple facilities that had outbreaks and multiple cases in one week. But there are inconsistencies among organizations and their different locations. With missing or incorrect data, it will be difficult to see the path of COVID-19.
COVID-19, Medicare, and Telehealth
Telehealth has been around for years; there has been a slow uptick when it comes to adoption and access.8 Along with COVID-19 came the rise of telehealth, especially when CMS expanded coverage.9 Ironically enough, in 2017 an article from Today’s Geriatric Medicine discussed the missed opportunity for nursing home residents and telehealth.10 Modern problems require modern solutions. Thankfully, this solution was already set in place.
Being in isolation is tough on everyone, and seemingly more so on older people who are in nursing homes and don’t have the same access as those who are younger, and have more independence. As residents become mentally and emotionally vulnerable, some states have relaxed some of their policies to allow in-person visitation.11 Additionally, telehealth can be used for more than physician visits. Psychologists have taken to virtual sessions.12 It will be interesting to see the change in telehealth claims throughout 2020 compared to years prior. Will telehealth become the standard?