Two COVID Tidbits:

Background: 80% of nursing home patients die within a year.

Old People Die Alarmingly Quickly in Nursing Homes, Study Finds

Posted By Joe Eskenazi @EskSF on Thu, Aug 26, 2010 at 6:30 AM

If you’re going to put Grandma or Grandpa in a nursing home — don’t put off making a visit. That’s the upshot of a U.C. San Francisco study published this week, which reveals elders often don’t last very long in care facilities.

Of its sample of nursing home patients who died between 1992 and 2006, a full 80 percent were dead within one year, claims the study, which appears in the current edition of the Journal of the American Geriatrics Society

(UPDATE: Looked around for more data on nursing home mortality – it is made somewhat confusing, in that the definitions are not clear. What, exactly, is a nursing home versus Long Term Care? What kind of patient is in what kind of home? The most favorable study showed an expected annual mortality rate of 31.8% and an average stay of 2.2 years. Others were in between. Perhaps the 80% annual death rate is for a particular kind of nursing home? Alzheimer’s and dementias seem to take 5 or more years to kill their victims once they’ve been put in a home – perhaps the homes in the first study excluded such patients? Yet, even the low end annual mortality rate of 31.8% requires that nursing homes are home to a lot of people who are very near death.)

In France and Canada, most COVID 19 deaths are in nursing homes.

h/t to Clarissa’s Blog

In the body of the report, it explains that numbers are not available for the US, Italy, Spain and some other places. Too bad. In the US, with only 35 states reporting, the report notes that there have been at least 10,000 nursing home deaths.

If we assume, not much of a reach, that the US is most likely more like the western European countries (+ Canada) on the right than the mostly smaller countries on the left of this chart, then the US rate might be 50% or more. We’ll have to wait and see if those numbers ever get reported. (I’m not holding my breath.) Also note that these numbers presumably do not include those cared for at home who might otherwise be in a nursing home, or hospital patients – also likely very sick people with a very short life expectancy.

(Aside: we also should not assume homogeneity: some people in nursing homes are a lot closer to the end than others – no reason to suppose COVID 19 isn’t killing proportionately more of the very ill. In other words, it would be simple-minded to assume 20% of the nursing home deaths attributed to COVID 19 were of people who otherwise would have survived the year. I bet close to 100% would have died this year– something like 95%.)

The bottom line here: my confidence that the total US deaths this year will not be much higher than the UN pre-COVID projection of about 2.903M is solidified by just about all the data that comes out. If 200K deaths are assigned to COVID 19 – unlikely, if they’re playing fair (Ha! I slay me!), then the total would go up by maybe 100K (a bad flu season)- IF it’s only the nursing home deaths that are padding the totals. I’m thinking, based on the ongoing collapse of US death counts (6 straight days of declining daily totals – Spring is here!), 200K is well out of reach.

When it is said, as it has been, that 95% of the COVID deaths in the US are of people with one or more “comorbidity”, that is identifying a population that is already a lot nearer to dying than the typical healthy person. To put it another way, 5% of the people who die of COVID 19 were otherwise healthy – for 70K deaths, that 3,500 otherwise healthy people who died of COVID 19. Not to be gruesome, but some percentage, probably a very large percentage, of the remaining 66.5K dead were going to die this year anyway, and thus were presumably included in the original death projections, and will thus not add to the number of overall deaths.

Author: Joseph Moore

Enough with the smarty-pants Dante quote. Just some opinionated blogger dude.

12 thoughts on “Two COVID Tidbits:”

  1. I think you were mid-editing in the part about how many would live out the year, I suspect; it looks like you’re saying almost none of the folks in nursing homes would have died this year, otherwise, which doesn’t seem to fit the rest of the conversation.

      1. In other words, it would be simple-minded to assume 20% of the nursing home deaths attributed to COVID 19 were of people who otherwise would have survived the year. I’d bet it’s close to 100%, something like 95%.

        Maybe a dropped not, come to think of it.

      2. Thanks. Hmmm. OK, what I thought I was saying: if 80% of nursing home residents die within their first year anyway, and COVID 19 tears through a nursing home, it’s disproportionately killing off people in the 80% that were going to die anyway. Say 100 people died in a nursing home. If the virus acts randomly-ish, 20 of those 100 would have otherwise lived out the year. But there is no reason to suppose the virus acts that way; instead, it most likely kills off those in the 80%. Thus, I’d guess something like 95 out of the hundred were among those who would die anyway.

        Is that clearer? I could replace the text in the post…

      3. Maybe just change it to something like “I bet close to 100% would have died this year– something like 95%.”
        ?

      4. *salutes*

        At least I can see yours– when I read what I wrote, I “see” what I meant, until a day or so later. -.- Then I can see where one rephrasing ran into the other, and it doesn’t mesh.

      5. I, too, think that this is wiping out the folks who were likely to die this year– and instead of being able to die with their family near, they’re locked in, and alone, often because the very folks who have their kids/grandkids locked in have forced the nursing home to take known infectious cases.

  2. Two thousand people is a pretty good sized sample–but over 14 years, not quite so good, and I kind of suspect they were looking at some special subset of nursing home. We use to do visits at one, and a LOT of those folks were there for years on end, simply because they needed nursing the family couldn’t provide.

    Possibly a lot of people either are discharged to the hospital before death, or go to die at home?

    1. I also have spent a depressing amount of time visiting nursing homes, and, yes there are people there for years on end. But if there were a churn, if lots of people came in and died shortly, I for one would probably miss it. I only tend to notice the people there time after time.

      I’ll look for some other data. One source I looked at included all sorts of assisted living, and dementia care in with the nursing homes – their median survival time was about 15 months; average was about 2.5 years. This accommodates both your observations and mine: the average gets driven up by the people who survive for years, while the median says that half of the residence die within 15 months. I didn’t include that source, because it included LTC other than nursing homes.

      1. There’s also a good chance that a lot of folks in a “nursing home” are there basically because they are almost dead, and either they or their heirs are…making it so nobody has to come find them a week after they passed, basically. So there’s someone who is a professional and can call everyone to say good-bye.

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