Assisted Living Residents Experienced Increased Mortality During the COVID-19 Pandemic

Thomas, et al. (2021) observe, "The devastating effects of COVID-19 among older adults residing in long-term care settings have been well documented. Although much attention has been paid to COVID-19–associated mortality in nursing homes, less is understood about its effects on assisted living residents. Most assisted living residents are aged 80 years or older and many have multiple chronic illnesses, making them highly susceptible to poor outcomes of COVID-19."

The study by Thomas, et al. (2021) examines the excess mortality among a U.S. cohort of assisted living residents during the COVID-19 pandemic.

Almost one-half of the researchers' sample (48%) was older than 85 years, 66% of participants were women, and 90% of participants were White. All-cause mortality rates, nationally, were significantly higher in 2020 compared with 2019 (mean, 2.30 vs 2.02 deaths per 1000 residents per week; aIRR, 1.169; 95% CI, 1.142-1.197; 17% higher overall mortality). During the peak week in 2020 (April 8 to 14), assisted living resident mortality was 3.28 deaths per 1000 residents per week compared with 2.24 deaths per 1000 residents during the same week in 2019 (aIRR 1.359; 95% CI, 1.207-1.529). New York had the greatest excess mortality between 2020 and 2019 (mean, 2.50 vs 1.57 deaths per 1000 residents per week during January to August) followed by New Jersey (2020 vs 2019, 3.03 vs 2.09 deaths per 1000 residents per week). Among the 10 states with the highest community spread during this period, excess mortality was 2.39 deaths per 1000 residents per week in 2020 during January to August vs 1.93 deaths per 1000 residents per week during January to August in 2019 (aIRR, 1.241; 95% CI, 1.185-1.299; peak week, 4.49 vs 2.37 deaths per 1000 residents per week; aIRR, 1.728; 95% CI, 1.380-2.163; 24% higher mortality) (Figure 2).

After adjusting for facility fixed effects, assisted living residents experienced 17% higher overall mortality in 2020 compared with the year prior (24% higher mortality in the 10 states with the greatest community COVID-19 spread during the study window). These results suggest that assisted living residents experienced increased mortality during the COVID-19 pandemic consistent with increases observed among nursing home residents.

The researchers note, "The increase in resident mortality we observed is likely an underestimate of the overall excess mortality during the pandemic given the lag in Vital Status data and the period studied (ie, the analyses were through August 11, 2020, and did not include later surges). Additional limitations include our inability to identify the cause of death and our exclusion of Medicare beneficiaries residing in smaller assisted living settings. Furthermore, we were unable to identify and exclude Medicare beneficiaries who shared a 9-digit residential zip code with a licensed assisted living community but lived elsewhere and residents who relocated after January 1, 2020. Nonetheless, our results provide a first look into the excess mortality during the COVID-19 pandemic among a national cohort of Medicare beneficiaries residing in assisted living."

They add, "Future state and federal responses to pandemics targeted to long-term care are advised to explicitly identify the experiences of assisted living settings, recognizing that they differ from nursing homes in terms of overriding model of care (eg, social vs medical model) and staffing (e.g., lower staffing levels and less nursing care), among other areas. In summary, this research calls for specific attention to assisted living in response to pandemics and other emergencies."

Reference: Thomas KS, et al. Estimation of Excess Mortality Rates Among US Assisted Living Residents During the COVID-19 Pandemic. JAMA Netw Open. 2021;4(6):e2113411. doi:10.1001/jamanetworkopen.2021.13411