CMS Study Shows Astonishing Disparity Between COVID-19 Cases in Nursing Homes and the Community

A recently published study by the U.S. Centers for Medicare & Medicaid Services (CMS) is sure to add more fuel to the fire for the “Choose Home” initiative and other movements aiming to bring more care into the home.

Specifically, the study found that although nursing home residents only represent 2% of the Medicare population, they accounted for 22% of all COVID-19 cases among Medicare members.

The study period was between March 1, 2020, and Dec. 31, 2020, accounting for the majority of the COVID-19 pandemic in the U.S. thus far.


“Nursing home residents were 14 times more likely to be diagnosed with COVID-19 compared to beneficiaries in the community,” the analysis read, offering a caveat. “It is unclear what impact the lack of widespread testing early in the pandemic may have had on these case rates.”

Among dual-eligible patients, those in nursing homes were 10 times more likely than those in the community to be diagnosed with COVID-19.

Minority nursing home residents felt the most adverse impact, contracting COVID-19 — on average — at a higher clip than their white counterparts.


Despite ebbs and flows to COVID-19 case counts throughout 2020 and preventative measures being implemented in nursing homes as the crisis went on, nursing homes remained a hotbed for infections throughout the year.

The potential impact on legislation

Introduced to the U.S. Senate in late July, the Choose Home Care Act of 2021 created both positive buzz around the home health industry and negative buzz from non-home health sectors, such as skilled nursing facility (SNF) stakeholders.

Broadly, the bipartisan legislation aims to allow home health providers to take on certain patients that would otherwise be eligible for nursing home-level care following a hospital stay, enabling home health agencies to receive an add-on payment for that care.

The momentum the bill gained prior to its introduction to the Senate was partly due to the havoc that COVID-19 wreaked on nursing home communities during the pandemic.

At this point, there are a plethora of organizations supporting the Choose Home Care Act, but providers such as the Louisiana, Lafayette-based LHC Group (Nasdaq: LHCG) specifically have been touting its value for a while.

“The home health industry has long felt that care in the home should be the center of health care,” Bill Dombi, president of the National Association for Home Care & Hospice (NAHC), recently told Home Health Care News. “And this is a step in that direction.”

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL), which represents more than 14,000 nursing homes and other long-term care facilities across the country, voiced its displeasure when the Choose Home Care Act was announced.

“We adamantly oppose this bill in its current form,” its statement read. “The complex Choose Home Care Act would supplant existing benefits, create duplicative payments, confuse beneficiaries, and increase out-of-pocket costs. At the same time, this legislation lacks clear quality and safety provisions, leaving patients vulnerable to inadequate care.”

NAHC responded, calling the statement “wholly inaccurate,” and reiterating that Choose Home was about patient choice and not providers.

“The Choose Home benefit does not have any cost sharing or cost shift to beneficiaries,” Dombi responded. “The proposal expands options for high quality care in one’s own home without a cost shift, with significant quality of care standards, and with the patient in full control of crucial health care decisions supported by comprehensive information on those choices while achieving savings to Medicare. It is very disappointing that AHCA/NCAL chooses to offer such unfounded allegations. This legislation is about patient choice, not the business interests of health care providers. Notably, there are many nursing homes that support the proposal.”

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