Nearly half of Missouri’s COVID deaths occurred in nursing homes

Nearly half of all coronavirus deaths in Missouri have occurred in nursing homes, with the highest total coming in St. Louis County, according to a new analysis of federal data from Saint Louis University researchers.

At least 24 facilities around the state have reported 100 or more cases among residents and staff, and at least three long-term care facilities in Missouri have seen 30 or more residents die from the virus, according to the findings.

The analysis sheds light on the scope of the virus’ toll on Missouri’s nursing home facilities, which have become hotspots nationwide and present an increased risk of transmission for residents and staff.

The data comes from nursing home cases and deaths posted by the Centers for Medicare and Medicaid Services. It represents cases and deaths as of Oct. 11. The Centers for Medicare and Medicaid Services’ data only includes federally-licensed nursing homes, and not other types of residential care facilities that may be licensed with the state.

The analysis was calculated by Timothy Wiemken, an associate professor in the Saint Louis University School of Medicine’s department of health and clinical outcomes research and division of infectious diseases, allergy, and immunology, and Chris Prener, an assistant professor of sociology at Saint Louis University who has been closely tracking and compiling data on the virus’ spread in Missouri.

“It’s really heartbreaking,” Wiemken said of the numbers. “We have these frail individuals who have been there for who knows how long and they get this virus and they die — and they’re dying alone.”

Among the findings:

• 1,241 deaths have been reported in Missouri nursing homes and long-term care facilities, making up 46.34 percent of all reported COVID deaths to date in Missouri. Of those deaths, 1,225 have been among residents and 16 have occurred among staff.
• 13,486 cases have been reported in Missouri nursing homes and long-term care facilities. These represent 8.12 percent of all COVID cases reported to date in Missouri. Of those cases, 7,704 have been among residents and 5,782 have occurred among staff.
• In 18 counties, 100 percent or more of the deaths are attributed to long-term care facilities. In another 12 counties, between 75% and 99 percent of fatalities have occurred in such facilities.
• As of Oct. 11, the counties with the most cases in long-term care facilities were the counties of St. Louis with 2,911 cases and Jackson with 984 cases.
• As of Oct. 11, the following facilities had the highest total cases among residents and staff: Creve Coeur Manor in St. Louis with 248 total cases, Woodland Manor Nursing Center in Arnold with 189 cases, Levering Regional Health Care Center in Hannibal with 164.
• As of Oct. 11, the following facilities had the highest total deaths among residents and staff: Riverbend Post Acute Rehabilitation in Kansas City with 37, Heritage Care Center in St. Louis with 35 and NHC Healthcare in Maryland Heights with 33.

Interactive maps and searchable databases that display more facilities can be viewed online here.

Nikki Strong, the executive director of the Missouri Health Care Association, which represents over 65 percent of Missouri’s licensed, long-term health care facilities, said that she could not comment on the specific figures as she had not yet reviewed them. However, the numbers weren’t surprising, she said, since long-term care facilities care for people who are often most susceptible to developing severe illnesses if they contract COVID-19 — both due to their age and underlying health conditions.

“Any death in a nursing home or any death from the virus — period — is tragic,” Strong said.

Nursing homes in Missouri first shut down back in March, and guidance on visitors was only recently relaxed in late September. Staff have had to navigate changing standards as they learn more about the virus, which can be difficult to contain in a congregate care setting, Strong said. 

“Nursing homes had to completely turn upside down their operations and completely change them,” Strong said. “And I don’t think anyone understands how difficult that is, especially when you’re shut down.”

As cases continue to rise and take hold in Missouri’s rural areas, Wiemken said he anticipates more outbreaks in long-term care facilities will follow.

Prener noted that in some cases, long-term care facility deaths are being reported and posted at the federal level faster than the state. 

For example, for Howell County in Southern Missouri, DHSS reports a total of six COVID deaths. Meanwhile, according to the Centers for Medicare and Medicaid Services data there have been 14 resident deaths at long-term care facilities for the county.

Some counties’ overall mortality rates do not yet reflect all of these deaths – you’ll notice counties like Howell, which DHSS has reported 6 deaths for but CMS lists 14 deaths in nursing homes there. This is yet another indictment of the state’s data. 4/21 pic.twitter.com/wMrkA775Eg

— Chris Prener (@chrisprener) October 23, 2020

While DHSS added data on new resident cases in the past seven days broken down by county to its COVID dashboard Thursday morning, Jerry Dowell, the vice president of public policy for the Alzheimer’s Association of Greater Missouri, said more is needed.

Dowell said the chapter is specifically calling for nursing home data to be shared at the facility level in a timely, accessible manner by the state. 

DHSS has previously refused to name facilities with COVID cases, arguing doing so would violate state statutes that prevent them from identifying patients, according to the St. Louis Post-Dispatch.

“And if it requires a statute change, we would be one of the first ones to lead the call, because this is not going to be the first time that we experience, I hate to say it, a pandemic in the future,” Dowell said. “I hope it doesn’t happen. But I think we should take some of these lessons learned from some of the hardships and other things that we’ve experienced. What are the things that we need to fix?”

A spokesperson for DHSS did not immediately respond to a request for comment Thursday on the findings. A representative for the Missouri Association of Nursing Home Administrators declined to comment.

In a statement Thursday afternoon, Gov. Mike Parson said the virus has had a major impact on the state’s most vulnerable residents, “and we are deeply saddened by the tragic loss of lives in long-term care facilities.”

“We learned early on that residents in long-term care facilities were not only at a higher risk for COVID-19 but also for poor outcomes,” Parson said in a statement. “Throughout COVID-19, we have worked closely with long-term care facilities and local health authorities to aggressively expand testing, prevention, and mitigation efforts, and we will continue to do so moving forward.”

A spokeswoman for the governor shared a fact sheet summarizing steps the state has taken, including conducting more than 1,200 on-site infection control audits, issuing testing guidance and ordering facilities to report positive tests within 24 hours.

But advocates are calling for more.

Dowell said he would like to see better training for facility staff, CARES money quickly dispersed to communities with large outbreaks and a clearer “surge activation plan” that lays out protocols for facilities with outbreaks.

Ultimately, to help reduce the virus’ chances of making its way into nursing homes, members of the community must also abide by best practices, both Dowell and Strong said.

“We need to be putting a lot more effort into prevention of infections in these vulnerable populations,” Wiemken said.