COVID-19 Deaths in Nursing Homes Disproportionally Impact People of Color

Nurse visiting an older patient.

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Key Takeaways

  • A research study found that nursing homes with the highest proportion of non-White residents experienced 3.3 times more COVID-19 deaths than predominantly White nursing homes.
  • Some factors driving these racial disparities include the size of nursing home facilities and the prevalence of COVID-19 in the neighboring community. 

Throughout the course of the pandemic, nursing homes have become hot spots and breeding grounds for COVID-19. And communities of color have borne the brunt of the impact, experiencing higher rates of COVID-19 infection and death.

A research study from the University of Chicago found that nursing homes with the highest proportion of non-White residents experienced 3.3 times more COVID-19 deaths than predominantly White nursing homes.

"Focusing limited available resources on facilities with high proportions of non-White residents is needed to support nursing homes during potential future outbreaks," the researchers wrote. The study was published in JAMA Network Open in February 2021.

Why Is There a Gap?

The researchers and experts point to a few factors leading to higher COVID-19 deaths in nursing homes with a greater proportion of BIPOC individuals. Issues like facility size, COVID-19 transmission in the overall community, and lack of resources have all contributed to disproportionate cases.

Staffing, Resources, and Medicaid

Tamara Konetzka, PhD, health economist, professor at the University of Chicago in the department of public health sciences, and the study’s co-author, tells Verywell that the differences were in large part due to nursing home size. The study found that nursing homes with higher percentages of non-white residents were larger and larger facilities were more likely to experience worse outbreaks. 

“Non-Whites, especially Blacks and Hispanics, tend to get nursing home care in facilities that have lower staffing ratios, that tend to perform worse on a variety of quality measures,” Konetzka says. In addition, Konetzka adds that nursing homes that depend on Medicaid tend to be those with insufficient resources to invest in quality care when compared to private homes. “It all comes down to resources, having enough reimbursement, staffing ratios.” 

Nursing home care in the U.S. is a two-tiered system with the lower tier consisting of mainly Medicaid residents. 15% of non-hospital-based nursing homes that serve predominantly Medicaid residents have fewer nursing staff and lower occupancy rates.

Research shows that lower staffing levels are linked to worse health outcomes. For example, in nursing homes with high registered nurse staffing, patients had lower rates of hospital admission and emergency room visits than patients with low registered nurse staffing.

COVID-19 Transmission in the Greater Community

The prevalence of the virus in the surrounding community also plays a significant role. Throughout the pandemic, COVID-19 has disproportionately impacted communities of color.

“Overall, the increase in mortality is reflective of the communities in which nursing homes are located," Julita Mir, MD, infectious disease physician and chief medical officer of Community Care Cooperative in Boston, tells Verywell. "We have seen throughout the pandemic that communities of color have been disproportionately affected by COVID-19 due to the systemic health and social inequities people from racial and ethnic minority groups face."

The APM Research Lab found that Indigenous, Black, and Pacific Islander Americans have experienced the highest COVID-19 death tolls. “There's data that has come out about the pandemic in general, that there have been a lot of racial and ethnic disparities in just who’s getting sick and who’s dying from the disease,” Konetzka says. “It’s really about location and whether or not you’re in a virus hotspot.” 

If the prevalence in the community is high, it puts nursing homes in that area at a greater risk. “You have staff going in and out every day, and therefore, those nursing homes are much more at risk,” Konetzka explains. 

Mir says that staff has largely been the source of outbreaks within nursing homes and long-term care facilities. “Occupational health and infection control practices need serious oversight,” Mir says. 

Collecting Data

Data collection during the pandemic has been a significant challenge. Mir stresses that there is not enough data to determine if this is a nationwide problem, underscoring the importance of reporting COVID-19 infection and deaths in nursing homes across the country.

“There have been challenges in getting accurate reports from nursing homes in many states,” Mir says. 

Recently, New York has been under fire for potentially underreporting deaths in nursing homes within the state.

What This Means For You

If you have a loved one living in a nursing home or long-term care facility, call your facility to learn more about their COVID-19 safety protocols and ways to keep them safe. To check the status of nursing home visits in your state, you can visit AARP’s nursing home visitation policies map.

Preventing COVID-19 Deaths

In order to prevent further deaths in nursing homes, facilities need a comprehensive approach. “It should include strict infection control practices, occupational health protocols and policies, and sufficient protective equipment and resources,” Mir says. Additionally, Mir adds that spaces need to ensure proper social distancing and that there should be designated areas for COVID-19 positive individuals.

“More importantly, education to staff, outside visitors, vendors, clinicians, and patients themselves is critical as there have been examples of breakdowns in infection control practices,” Mir says. 

The pandemic has given rise to challenges in maintaining long-term care facilities. Mir sees this as a perfect time for public health departments to review protocols and improve the processes and oversight of nursing homes to advance the health of everyone, especially for communities of color.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Gorges RJ, Konetzka RT. Factors associated with racial differences in deaths among nursing home residents with COVID-19 infection in the US. JAMA Netw Open. 4(2):e2037431. doi:10.1001/jamanetworkopen.2020.37431

  2. Mor V, Zinn J, Angelelli J, Teno JM, Miller SC. Driven to tiers: socioeconomic and racial disparities in the quality of nursing home care. Milbank Q. 82(2):227-256. doi:10.1111/j.0887-378X.2004.00309.x

  3. Yang BK, Carter MW, Trinkoff AM, Nelson HW. Nurse staffing and skill mix patterns in relation to resident care outcomes in us nursing homes. J Am Med Dir Assoc. doi: 10.1016/j.jamda.2020.09.009

  4. Centers for Disease Control and Prevention. Health equity considerations and racial and ethnic minority groups.

  5. APM Research Lab. The color of coronavirus: COVID-19 deaths by race and ethnicity in the U.S.

By Kayla Hui, MPH
Kayla Hui, MPH is the health and wellness ecommerce writer at Verywell Health.She earned her master's degree in public health from the Boston University School of Public Health and BA from the University of Wisconsin-Madison.