As Ohio contends with a historic epidemic, residents of the state’s nearly 1,000 nursing homes are taking the brunt of the damage. As of last week, 2,100 of Ohio’s 2,600 COVID-19 deaths since mid-April — about 4 in 5 deaths — were among nursing home residents.
The extent to which COVID-19’s death burden has fallen on Ohio’s elderly is surprising given what we have experienced with similar diseases. While the CDC reports that 3 in 4 U.S. influenza deaths in the 2018-2019 season were among those age 65 and older, Ohio Department of Health data suggests over 9 in 10 COVID-19 deaths have been among those age 60 and older.
While ODH doesn’t report individualized age data more fine-grained than the decade level in order to maintain anonymity of COVID-19 patients, by looking at the percentage of deaths that have been among those 60 and older and 70 and older, we can conservatively estimate that 84% of COVID-19 deaths in Ohio have been among those 65 and older, a full nine percentage points higher than nationwide flu deaths last year.
Part of this might have to do with the US’s reliance on long-term care. According to the OECD, the United States has more people in nursing homes than any other developed country. An NBER working paper last month by UCLA and Yale researchers used smartphone data from 30 million phones to find a significant number of cell phones appearing in multiple nursing facilities, probably due to staff working at multiple homes. They estimate that these staff linkages have made nursing home facilities even more dangerous for residents, leading to almost half of nursing home infections via transmission from staff.
While nursing homes are certainly the right options for some families, many researchers think that the US’s reliance on them lead to worse outcomes for elderly people, even for those with dementia. Assisted living in independent or family settings can potentially lead to more community connectivity and independence for people in their final years at a lower cost than nursing homes require.
Because of these factors, the state of Ohio has dramatically shifted its funding from nursing home care to assisted living over the past ten years. The hope is that this change will save money for the state while improving outcomes for seniors.
One thing is for certain, though: those still in nursing homes have been left most at risk during this global pandemic. And while we didn’t know the extent to which COVID-19 would threaten Ohio’s elderly population, we knew they would be most at risk and that nursing homes would, in particular, be the most important places for mandated social distancing.
COVID-19 didn’t have to ravage nursing homes the way it did this year. Japan has nearly as many people in nursing homes as the United States does but less than 1% of total deaths the US has experienced. Despite their heavy reliance on nursing homes, they were more prepared than we were, and COVID-19 has showed us that there is no substitute for proper preparation when it comes to a global pandemic.