Nursing homes, after seeing improvements, now face a fresh COVID-19 threat

Nursing homes across the country are bracing for a dark winter as rising coronavirus infections appear to be reversing trends that had showed an improved outlook for the nation's most vulnerable, an ABC News review of state-by-state numbers reveals.

"As case counts rise in communities around the country, nursing homes and providers in other congregate care settings are under siege," said Katie Smith Sloan, president and CEO of LeadingAge, the association of nonprofit providers of aging services. "Despite the improvements in testing, older adults in nursing homes -- and in all care settings -- continue to be under threat from this pandemic."

Overall, the toll on seniors has been grim. Through late October, coronavirus deaths in nursing homes and long-term care facilities have now topped 82,000 in the 41 states for which figures were available, according to ABC News' analysis of state-released data.

The figures appear to show that nursing homes saw significant improvements late in the summer, with cases in those settings making up a smaller percentage of the overall infections in most states. By August, nursing home deaths were also increasing at a much slower rate as a percentage of overall infections.

Those gains reflected steady improvements in the ability of doctors to intervene and treat COVID-19 infections before they became life-threatening, experts said. Nursing homes were testing more frequently, isolating infected residents earlier, and using better therapies to treat the illness, several industry officials told ABC News.

"Testing has made a significant difference in our ability to manage and contain the virus," said Dr. Mark Gloth, chief medical officer at ProMedica Senior Care, one of the nation's largest residential nursing care providers with more than 300 nursing, assisted-living and hospice care facilities.

In-house testing has made it easier to spot contagious residents before they show symptoms, Gloth said, adding that the benefits of earlier intervention are most notable because over 50% of the positive cases they have seen have been asymptomatic.

"Our mortality rate continues to decline significantly," Gloth said. But in the last two weeks, he said the company has seen "isolated increases" as coronavirus cases have surged in large swaths of the country.

National figures compiled by ABC News indicate that earlier positive trends in the industry overall may be backsliding.

In Maryland, where the percentage of the state's coronavirus deaths among those in nursing homes had been steadily dropping, the figure rose from a low of 32% in August to 53% by the end of October. In Oregon, where nursing home deaths made up fewer than half of the state's COVID-19 deaths, they now make up more than 57% of the state's overall coronavirus death totals.

In New York, the number of new nursing home deaths has remained low compared to some of the other states where the death count has been raging, but there has been a recent surge in nursing home deaths in the last few weeks. More the twice the number of new nursing home deaths were reported in the last four weeks compared to the previous four weeks.

The number of cases in Arkansas nursing homes has tripled from September to October, while deaths have increased by almost a third. In Delaware, nursing homes saw cases increase in October and saw a third more deaths than in the previous month. Texas, Utah and West Virginia all saw similar trend lines, with the ratio of nursing home deaths on the rise by late October, after having seen a dip through August.

"As we move into a second wave, we need to make sure we apply lessons from earlier in the pandemic to curb transmission and save lives," said Dr. Jay Bhatt, a practicing internist and ABC News contributor. "Infection prevention and prevention measures used by staff and residents will be critical in the coming months."

One significant challenge, Bhatt said, will come as nursing homes shut down access to residents' relatives and friends at a time many have only recently loosened restrictions. Social isolation, he said, has been associated with about a 50% percent increased risk of dementia.

"I'm deeply concerned about the continued isolation that older adults face in nursing homes," Bhatt said.

Last week, one of the nation's largest nursing home industry advocacy groups sent out an alert about the "threat of a third spike," saying many providers "still need essential resources such as personal protective equipment and testing." The American Health Care Association said that one in five facilities were dangerously low on items like gloves and hand sanitizer.

"The shortages actually became more grave as the summer went on," according to a recent study by the U.S. Public Interest Research Group cited in the industry alert, "with three times as many nursing homes reporting they were completely out of masks, gowns and eye protection in late August, compared with mid-July."

In Wisconsin, where overall coronavirus cases, hospitalizations and deaths are all rising rapidly, the percentage of fatalities occurring in nursing homes is also going back up. After dropping to as low as 15% of all deaths in August, that rate doubled to 30% in October.

That month, John Sauer, the president of advocacy group LeadingAge Wisconsin, wrote to the head of the federal agency that regulates nursing care and pleaded for more assistance.

"Our members are facing an unprecedented crisis and, with our State's exponential surge in COVID-19 cases, this crisis is intensifying, threatening facilities' ability to serve current residents or accept new admissions from our acute-care partners," Sauer wrote. "In short, the Wisconsin long-term care safety net is unraveling. Our system is collapsing, and we need your help."

ABC News' Olivia Rubin and Allison Pecorin contributed to this report.