Skilled Nursing Occupancy Held its Ground During the Omicron Spike Despite High Caseload and Severe Staffing Challenges
February 22, 2022
Omicron within skilled nursing facilities accounted for about seven percent of U.S. fatalities, higher than the Delta but far below the Fall 2020 spike.
While COVID-19 cases in the country and within skilled nursing facilities (SNFs) were very high during the Omicron surge in January 2022, data shows that fatalities among SNF residents remained significantly below the fall 2020 spike prior to the vaccine rollout.
The high caseload recorded in January 2022 exacerbated staffing shortages due to sickness-related absenteeism among SNF workers. However, SNF occupancy (based on CMS data) remained relatively stable compared with the sharp downturn during the fall 2020 spike prior to the vaccine rollout. This is mainly due to the fast retreat of Omicron, the reduced level of severe illness and fatalities, and pandemic preparedness among operators acquired from prior waves.
In this analysis, we provide a summary of the COVID-19 situation within SNFs and assess the impact of the Omicron spike on occupancy for skilled nursing facilities compared with the Delta and fall 2020 COVID-19 spikes. The analysis also showcases the noteworthy contribution and essential role of vaccines in mitigating the risk of severe illness and limiting fatalities among SNF residents.
Weekly COVID-19 cases in the country and within SNFs are currently dropping fast and at the same pace in which they peaked.
NIC’s Skilled Nursing COVID-19 Tracker, featuring CDC data as of February 13, 2022 (U.S. cases data) and CMS data as February 6, 2022 (SNF cases data), shows that COVID-19 cases in the country and within SNFs are falling fast and at the same pace in which they peaked. Weekly COVID-19 cases in the country fell by 80% from their January 16 peak of 5.58 million cases to 1.13 million cases on February 13 and are now near pre-Omicron levels.
Similarly, case counts within SNFs are falling sharply and following the same trajectory as weekly tallies in the country. New cases among SNF workers have fallen by 63% from their January 16 peak of nearly 68,000 to less than 23,000 cases on February 6. Over the same period, newly confirmed cases among residents have fallen by 55%, from about 48,000 cases on January 16 to less than 22,000 on February 6.
For the week ending February 6, 2022, per-resident rate of new COVID-19 infections dropped to 2% (about 200 in 10,000 residents tested positive), down 2.3 percentage points (pps) from its record high in mid-January 2022 of 4.3%.
Regionally, SNFs in the South region reported the highest per-resident rate of new COVID-19 infections at 2.75% (down 1.85pps from January 16), followed by the Midwest (1.71% – down 1.67pps from January 16), the West (1.53% – down 2.56pps from January 16), then the Northeast (1.35% – down 3.45pps from January 16).
Weekly COVID-19 fatalities among SNF residents falling and remained relatively low compared with the highest level seen during the fall 2020 spike.
At the height of the Omicron surge in January 2022, weekly COVID-19 cases among SNF residents set a new record at about 48,000 new cases, 45% above the peak recorded in December 2020 of about 33,000 new cases. However, weekly COVID-19 fatalities remained relatively low and far below the highest level seen back in fall 2020 prior to the vaccine rollout. In fact, weekly COVID-19 fatalities among residents during the Omicron surge peaked at about 1,500 on January 23, 2022, 75% less than the peak recorded on December 20, 2020 of nearly 6,000 new fatalities.
Per-resident rate of COVID-19 fatalities stood at 0.10% on February 6, down 3 basis points from its peak during the Omicron surge on January 23, 2022 and is now 44 basis points below the fall 2020 peak of 0.54% on December 20, 2020.
SNF Occupancy held its ground despite high caseload and severe staffing challenges.
The high COVID-19 caseload exacerbated staffing shortages among SNF workers in January 2022. The exhibit below shows that the declining case tallies within SNFs started to alleviate staffing shortages caused by sickness-related absenteeism among workers. Notably, the share of SNFs reporting staffing shortages among nursing staff, aides, and other staff took a downward trend following the sharp decline in case counts. For the week ending February 6, 2022, about 28.6% of SNFs reported shortages of aides, 26.7% reported shortages of nursing staff, and 17% reported shortages of other staff.
Interestingly, occupancy for SNFs (based on CMS data) held its ground and remained somewhat stable during both the Omicron and Delta spikes compared with the fall 2020 spike. During the Omicron spike, SNF occupancy fell by 0.7pps, from 72.4% on December 19, 2021 to 71.7% on January 23, 2022, then inched up 0.2pps to 71.9% on February 6, 2022. Similarly, SNF occupancy during the Delta spike fell by 0.3pps, from 71.9% on August 1, 2021 to 71.6% on September 12, 2021.
The fall 2020 spike weighed heavily on SNF occupancy. The exhibit below shows that occupancy dropped by 3.7pps, from 71% on October 11, 2020 to 67.3% on January 10, 2021 (the lowest level of occupancy since the onset of the pandemic). This was mainly due to a relatively long-lasting fall 2020 spike and the high level of fatalities in the early days of the pandemic prior to the vaccine rollout.
COVID-19 vaccines made an extraordinary contribution to mitigate the risk of severe illness and limit fatalities among SNF residents.
The analysis below shows that during the fall 2020 spike prior to widespread vaccinations among SNF residents, COVID-19 fatalities among SNF residents accounted for 30% of total fatalities in the country. over 52,000 SNF residents died over the period from the week ending October 11, 2020 to the week ending January 10, 2021.
During the Delta spike. As vaccines have been administered for most residents of skilled nursing facilities (as of August 1, 2021, 83% of residents had been fully vaccinated before the Delta took hold), fatalities among SNF residents as a share of total fatalities in the U.S. dropped to 4.7%, down over 25pps from the share recorded during the fall 2020 spike.
During the Omicron spike. At 7%, fatalities among SNF residents as a share of total fatalities in the country remained far below the share recorded during fall 2020 spike (30%), but 2.3pps higher than the share during the Delta spike (4.7%).
The COVID-19 stats below show that the Omicron spike has caused more fatalities among SNF residents than the Delta spike. This is partly due to the relatively high case counts and the lagging booster shots. As the Omicron variant took hold in December 2022, only 52% of fully vaccinated residents had received a booster, and only21% of staff.
Booster rates are increasing but still lagging. As of February 6, 2022, 60% of residents within SNFs had received a COVID-19 vaccine booster and roughly 30% of staff.
To gain in-depth insights and track vaccination coverage, U.S. weekly cases, and the week-over-week change rate for new resident cases and fatalities of COVID-19 within skilled nursing facilities at the state and county levels, visit NIC.org.
This blog was originally published on NIC Notes.
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