Assisted living residents experienced increased mortality in 2020, in line with the higher rates observed among nursing home residents during the pandemic, a new nationwide study finds.

The plight of nursing home residents has received the bulk of research and policy attention during the pandemic. But most assisted living residents are similarly susceptible to poor outcomes for COVID-19, investigators noted. Using data from the Centers for Medicare & Medicaid Services, they found that assisted living residents had 17% higher rates of overall mortality in 2020 compared with the year prior.

In the 10 states with the greatest community spread of COVID-19 during the study period, rates were even higher — at 24%. These included Rhode Island, South Carolina, New Jersey, Georgia, Alabama, New York, Mississippi, Florida, Arizona, and Louisiana, reported Kali S. Thomas, Ph.D., of the Center for Gerontology and Healthcare Research, Brown University, Providence, RI.

In the future, state and federal responses to pandemics and other health emergencies should “explicitly identify the experiences of assisted living settings,” Thomas and colleagues said. This identification should include recognizing where they differ from nursing homes, including in their social (versus medical) care model, lower staffing levels and less nursing care, they stated in a research letter, published Monday in JAMA Network Open

The data included more than 420,000 Medicare beneficiaries residing in licensed assisted living settings with 25 or more beds in 49 states and Washington, DC. Minnesota was excluded from the ZIP code-based study because it licenses agencies versus physical locations. Results were adjusted for facility effects. 

The increase in resident mortality likely is an underestimate, due to a lag in Vital Status data and the limited study period, which ended Aug. 11, 2020, the investigators noted.