Impact of the COVID-19 pandemic on long-term care facilities

Georgia National Guard disinfects common areas of a nursing home

The COVID-19 pandemic has impacted long-term care facilities and nursing homes around the world. Thousands of residents of these facilities, who are a high-risk group, have died of the disease.


As of mid-April 2020, nearly half of the COVID-19 deaths in Canada were at long-term care facilities.[1] Residences are provincially-regulated, meaning that standards are inconsistent as to worker to resident ratios, as does the minimum training.[2]

In British Columbia, the number of cases in long-term care facilities jumped from 9 to 235, including 143 residents and 92 staff.[3]

In Ontario on 18 March, an outbreak began in the Pinecrest Nursing Home in Bobcaygeon, and as of 6 April, 29 of its 65 residents have died as a result of COVID-19.[4][5] On 6 April, the City of Toronto discovered that a large shipment of Chinese-made masks delivered to its long-term care facilities were defective.[6] On April 16, the province decided to halt transfers to long-term care homes.[7]

In Quebec, a team of health care professionals inspecting Résidence Herron after a resident's death from COVID-19 found the facility largely abandoned by staff. Living conditions inside were similar to "a concentration camp", according to the officials.[8]


About a third of reported coronavirus deaths have occurred among residents—more than 3,000[5]—causing the homes to run low on body bags.[9] More than 2,300 homes have had at least one case reported.[5] Nursing home residents are being isolated in their rooms to slow the spread of the disease, while hospitals are reluctant to admit patients who have little chance of recovering.[9] Most elderly requiring care in France live in EHPADs.[10]


On 18 March, the first case were identified at the Hanns-Lije retirement home in Wolfsburg.[11] As 31 March, at least 17 died from COVID-19 in this residence.[12]

On 2 April, Robert Koch of the Institute in Germany, affirmed that as of 1000 German deceased,[13] 87% were older than 70 years. Of these, more than 50 were residents in nursing homes in Bavaria, Cologne and Wolfsburg.[14] By 9 April, 29 residents of the nursing home in the city of Wolfsubrg died.[15]


As of 9 April, 3,859 people have died in care homes operated by RSA since 1 February of whom 133 tested positive and 1,310 had symptoms consistent with coronavirus. Prosecutors are investigating a home in Milan where 27 residents died of suspected coronavirus infection during the first week of April.[5]


Many nursing homes in Spain are understaffed because they are for-profit businesses and elderly Spaniards cannot necessarily afford sufficient care;[16] the salary for most workers is less than €1,000 per month. Even before the crisis, safety violations occurred frequently. The lack of PPE and inability to quarantine infected individuals exacerbated the spread of the disease.[17] In some nursing homes, elderly victims were found abandoned in their beds by Spanish soldiers mounting emergency response. Defense minister Margarita Robles said anyone guilty of neglect will be prosecuted.[18] By 18 April, 38 residences were under investigation.[17] Some hospitals refused to admit sick people from nursing homes.[19] Thousands of elder care workers have been infected.[20] By 18 April, more than 13,600 Spaniards in nursing homes who were probable or confirmed coronavirus cases had died, including ten percent of nursing home residents in the Community of Madrid, while at least 39,000 were infected according to incomplete figures as some communities were not deaggregating their figures.[17]

United KingdomEdit

The death rate in care homes accelerated in April. Beginning 29 April, health secretary Matt Hancock said the government would begin daily reports of separate statistics for these facilities. This announcement was made after 4,343 deaths were reported in care homes between April 10-24; half of those deaths occurred during the last five days of the period.[21]

Sky News correspondent Alex Crawford wrote an editorial about care homes in general, and in relation to COVID, suggesting the situation was a "scandal" that future generations would question. She also noted care assistants' working conditions, including zero hour contracts, and homes urging sick employees to come in anyway.[22]

To prevent bringing COVID-19 into the facility, assistants at Liverpool's Beechside Home have moved in, as of April 2020.[22] Nearby Oak Spring has had 14 deaths in two weeks, as of mid-April; only two of the deceased were tested, and both were positive for COVID-19.[22] As of early April, that facility was operating with a quarter of its normal staffing, after the staff or their families were exhibiting symptoms, and were self isolating. Two-thirds of remaining residents were exhibiting symptoms.[23][24] The Member of Parliament for Liverpool, Paula Barker, has criticised the lack of PPE at social care facilities, compared to NHS workers.[25]

United StatesEdit

West Virginia National Guard assist nursing home staff with pandemic

On 17 April, the New York Times reported that there had been more than 7,000 deaths in American nursing homes—about a fifth of the national death toll—and more than 36,500 residents and employees had tested positive. This actual figure is considerably higher since many facilities are not reporting cases or deaths. Federal government has designated long-term care facilities as lower priority than hospitals for coronavirus testing, leading to longer wait times for results.[26] In addition to steps taken by individual facilities, the federal government has barred visitors, ended group activities, and instituted a mandatory testing regime for workers. However, this is not necessarily effective at preventing infections.[27] While some affected facilities are understaffed and have a history of safety violations, others are luxury facilities with excellent records.[26]

During April and early May, government inspectors identified violations of federal standards meant to prevent and control infection at nine locations of Life Care Centers of America.[28]


In California, Governor Gavin Newsom announced on 10 April that some healthy residents at nursing homes would be transferred to USNS Mercy, a US Navy hospital ship. The vessel previously was only expected to take patients from southern California hospitals, to free up space there for COVID-19 patients.[29] Six hundred nurses with infectious disease control training were to be dispatched to nursing homes and adult care facilities to contain the disease.[29] Some facilities have reorganized residents into discreet buildings for those with and without the virus.[29]


As of mid-April 2020, Florida Governor Ron DeSantis was considering a request to grant nursing homes "sovereign immunity" from negligence lawsuits during the pandemic. The request was made by a trade group that represents nearly 700 nursing homes in the state.[30]


A medic with the Massachusetts National Guard and a resident of the Life Care Center of Nashoba Valley nursing home handle a nasal swab that will be used to test for COVID-19

Life Care Center of Nashoba Valley experienced an outbreak in April 2020.[31][32] The nurse who reported the outbreak later died of the virus.[33]

One of the most severe outbreaks was at the state-run Holyoke Soldiers' Home for aging veterans. In late March, there were 210 residents; by late May, 74 of them had died with a COVID-19 diagnosis.[34] Dozens of employees also tested positive.[35]


Sagepoint Senior Living was fined $10,000/day by state regulators. The facility was notified on May 6, 2020 that the fine would be retroactive to March 30 and would continue until Sagepoint complied with state health regulations. At the time of the notification, 34 residents and 1 employee had died from COVID-19 in the 165-bed facility.[36]


The state of Minnesota held a legislative hearing on 7 April into the senior care industry, weeks into a lockdown. The executive director of one facility noted that her residents are showing signs of depression and anxiety from the confinement.[37]

New JerseyEdit

As of 17 April, two thirds of the state's long-term facilities—a total of 394—had reported cases of the virus, with 1,500 deaths linked to nursing facilities,[26] about 40% of the state's death count. One facility, Andover Subacute and Rehabilitation Center II, with 543 beds, had a record of safety problems and inadequate staffing. After an anonymous tip, police found seventeen bodies in bags on 13 April. Seventy residents had died of the disease by 19 April. Federal and state investigators have launched an investigation into the facility.[38]

New YorkEdit

As of early April, in New York state's 613 licensed facilities, there were nearly 5,000 COVID diagnoses.[39] By mid-April, 72 facilities had five or more confirmed deaths; Cobble Hill Health Center in Brooklyn reported 55 deaths.[26] By early May, it was estimated that 5,000 people had died in nursing homes in New York state.[40]


A Life Care Center facility in Kirkland, Washington was the source of a major outbreak of COVID-19 first reported on 19 February 2020, which became the first outbreak in a United States nursing home.[26] On February 19 there were 120 residents and 180 Center employees at the facility. By 18 March, 101 of the residents had been diagnosed with COVID-19, and thirty-four residents had died, for a case fatality rate of 33.7%.[41] On 2 April 2020 Life Care Center was fined $611,000 for deficiencies in its response to the outbreak, and has until 16 September 2020 to correct the deficiencies, or else face termination of its participation in the Medicare/Medicaid program.[42]


  1. ^ Bensadoun, Emerald (13 April 2020). "Nearly half of Canada's COVID-19 deaths linked to long-term care facilities: Tam". Global News. [Toronto ON]. Retrieved 13 April 2020.
  2. ^ CBC News (13 April 2020). "COVID-19: New federal guidelines for long-term care homes". Toronto ON: YouTube. Canadian Broadcasting Corporation. Retrieved 13 April 2020.
  3. ^ Little, Simon (9 April 2020). "B.C.'s coronavirus death toll hits 50 as cases mount in long-term care homes". Global News. Vancouver BC: Corus. Retrieved 11 April 2020.
  4. ^ "Two more COVID-19 deaths at Bobcayeon, Ont. seniors' residence". 4 April 2020.
  5. ^ a b c d Connolly, Kate (9 April 2020). "Care homes across globe in spotlight over Covid-19 death rates". The Guardian. Retrieved 13 April 2020.
  6. ^ Staff staff (7 April 2020). "City of Toronto recalls defective masks to long-term care homes; Deputy Minister of Foreign Affairs Canada tests positive for COVID-19; Alberta releases projections". Toronto Star. Toronto ON. Retrieved 11 April 2020.
  7. ^ Laura Stone; Karen Howlett; Les Perreaux (16 April 2020). "ADCHOICES Ontario places pause on transfers from hospitals to seniors' facilities; Quebec issues third plea for military aid". The Globe and Mail. Toronto ON. Retrieved 17 April 2020.
  8. ^ Derfel, Aaron (10 April 2020). "Public health, police find bodies, feces at Dorval seniors' residence: sources". Montreal Gazette. Montreal QC. Retrieved 11 April 2020.
  9. ^ a b "Nursing homes in Europe struggle with pandemic's uncounted dead". France 24. 1 April 2020. Retrieved 13 April 2020.
  10. ^ "Ehpad : établissement d'hébergement pour personnes âgées dépendantes". Retrieved 7 May 2020.
  11. ^ Salzmann, Markus. "Deaths from COVID-19 mount in German elderly care homes". Retrieved 16 April 2020.
  12. ^ Amanda Woods (31 March 2020). "At least 17 die from coronavirus at nursing home in Germany". New York Post. Retrieved 16 April 2020.
  13. ^ "Novel Coronavirus (2019-nCoV) situation reports". Retrieved 16 April 2020.
  14. ^ "Nursing homes in Europe struggle with COVID-19 pandemic". Retrieved 16 April 2020.
  15. ^ Connolly, Kate (9 April 2020). "Care homes across globe in spotlight over Covid-19 death rates". The Guardian. ISSN 0261-3077. Retrieved 16 April 2020.
  16. ^ Tremlett, Giles (26 March 2020). "How did Spain get its coronavirus response so wrong?". The Guardian. Retrieved 28 March 2020.
  17. ^ a b c "Residencias, la trampa mortal de los más vulnerables". EL PAÍS (in Spanish). 18 April 2020. Retrieved 19 April 2020.
  18. ^ Jones, Sam (23 March 2020). "Spanish minister says older people found 'dead and abandoned'". The Guardian. Retrieved 28 March 2020.
  19. ^ ""They just sedate them"; coronavirus overwhelms Spain's care homes". Reuters. 3 April 2020. Retrieved 10 April 2020.
  20. ^ Troya, María Sosa (3 April 2020). "Al menos 3.600 personas han muerto en residencias de mayores por el coronavirus". EL PAÍS (in Spanish). Retrieved 3 April 2020.
  21. ^ Booth, Robert (28 April 2020). "Care home fatalities to be included in daily coronavirus death tolls". The Guardian. ISSN 0261-3077. Retrieved 29 April 2020.
  22. ^ a b c Crawford, Alex (11 April 2020). "Coronavirus: What's happening in UK care homes right now is a scandal our grandchildren will ask about". Sky News. Retrieved 11 April 2020.
  23. ^ "Liverpool care home secures extra staff after residents show Covid-19 symptoms". ITV. Liverpool UK. 1 April 2020. Retrieved 11 April 2020.
  24. ^ "Coronavirus: 'Amazing response' to struggling care home's staffing plea". BBC News. Liverpool UK. 1 April 2020. Retrieved 11 April 2020.
  25. ^ Thorp, Liam (6 April 2020). "Joe Anderson says Liverpool 'still waiting' for PPE for NHS staff and carers". Echo. Liverpool UK. Retrieved 11 April 2020.
  26. ^ a b c d e Stockman, Farah; Richtel, Matt; Ivory, Danielle; Smith, Mitch (17 April 2020). "'They're Death Pits': Virus Claims at Least 7,000 Lives in U.S. Nursing Homes". The New York Times. Retrieved 18 April 2020.
  27. ^ "Nursing home deaths soar past 2,700 in alarming surge". AP NEWS. 12 April 2020. Retrieved 12 April 2020.
  28. ^ Cenziper, Debbie; King, Sidnee; Mulcahy, Shawn; Jacobs, Joel (16 May 2020). "Major nursing home chain violated federal standards meant to stop spread of disease even after start of covid-19, records show". Washington Post. Retrieved 17 May 2020.
  29. ^ a b c Phil Willon; Jack Dolan (10 April 2020). "California moves to protect nursing home residents from the coronavirus". Los Angeles Times. Los Angeles CA. Retrieved 11 April 2020.
  30. ^ Marbin Miller, Carol (15 April 2020). "Nursing home industry, already granted favors by DeSantis, wants another — this one big". Miami Herald. Retrieved 16 April 2020.
  31. ^ "Town of Littleton Information Center | Littleton MA". Retrieved 13 April 2020.
  32. ^ "Whistleblower nurse who spoke out about Littleton nursing home dies of COVID-19". WCVB. 12 April 2020. Retrieved 13 April 2020.
  33. ^ Staff, Laura Crimaldi Globe; April 11, Updated; 2020; Comments, 7:06 p m Email to a Friend Share on Facebook Share on TwitterPrint this Article View. "Nurse at Life Care Center of Nashoba Valley dies of COVID-19 - The Boston Globe". Retrieved 13 April 2020.CS1 maint: numeric names: authors list (link)
  34. ^ Barry, Ellen (24 May 2020). "They Survived the Worst Battles of World War II. And Died of the Virus". The New York Times. ISSN 0362-4331. Retrieved 24 May 2020.
  35. ^ Richer, Alanna Durkin (28 April 2020). "Nearly 70 Dead in 'Horrific' Outbreak at Holyoke Soldiers' Home". NECN. Retrieved 30 April 2020.
  36. ^ Chason, Rachel (7 May 2020). "Md. nursing home with most deaths to be fined $10,000 a day since March 30". Washington Post. Retrieved 7 May 2020.
  37. ^ Serres, Chris (8 April 2020). "Minnesota nursing homes launch aggressive new safety measures to control virus". StarTribune. MN. Retrieved 12 April 2020.
  38. ^ Tully, Tracey; Rosenthal, Brian M.; Goldstein, Matthew; Gebeloff, Robert (19 April 2020). "70 Died at a Nursing Home as Body Bags Piled Up. This Is What Went Wrong". The New York Times. Retrieved 20 April 2020.
  39. ^ Amy Julia Harris; John Leland; Tracey Tully (11 April 2020). "Nearly 2,000 Dead as Coronavirus Ravages Nursing Homes in N.Y. Region". The New York Times. New York City NY. Retrieved 11 April 2020.
  40. ^ Goheen, Marcella (25 May 2020). "Opinion | The Crisis at My Husband's Nursing Home". The New York Times. ISSN 0362-4331. Retrieved 25 May 2020.
  41. ^ McMichael, Temet, Ph.D.; Currie, Dustin, Ph.D.; Clark, Shauna, R.N.; Pogosjans, Sargis, M.P.H.; Kay, Meagan, D.V.M.; Schwartz, Noah, M.D.; Lewis, James, M.D.; Baer, Atar, Ph.D.; Kawakami, Vance, D.V.M.; Lukoff, Margaret, M.D.; Ferro, Jessica, M.P.H.; Brostrom-Smith, Claire, M.S.N. (27 March 2020). "Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington". The New England Journal of Medicine. doi:10.1056/NEJMoa2005412. PMC 7121761. PMID 32220208.
  42. ^ Q13 News Staff and Associated Press (2 April 2020) Life Care Center of Kirkland fined $611,000 over coronavirus outbreak response

External linksEdit