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Last week, states reported 29,606 new COVID-19 cases in nursing homes, assisted living facilities, and other long-term care facilities. This represents a 17 percent increase, the highest weekly rise since we started tracking this data in late May. We know that 15,443 of the week’s new cases represent long-term care residents and 8,054 represent staff. The remaining 6,109 new cases were not differentiated by the states that report them.

It’s important to reiterate that in addition to being alarming, these case numbers are almost certainly an undercount. There are approximately 44,500 long-term care facilities in the United States, according to a 2019 report from the US Centers for Disease Control and Prevention. We know there have been 25,875 outbreaks at facilities, which means that more than half of the LTC facilities in the US have had a COVID-19 case and/or death. While this may include facilities that had multiple outbreaks, resulting in them being counted twice, it’s still shocking that the virus has touched so many of the residents of these facilities. From the 30 states that report active outbreak data, there are currently 6,732 facilities that have a staff member or resident (or multiple staff members or residents) who recently tested positive for COVID-19.

The problem of combining staff and resident cases

Thirteen states lump together staff and residents when reporting cases, clouding our understanding of what’s happening within facilities. Illinois is one of those states, so although we can see cases rising very quickly there, it’s impossible to know how many of the cases are among residents and how many are among staff. Detecting more COVID-19 cases among staff could be the result of an effort to increase testing at facilities. A rise in cases among residents is much more likely to result in deaths. In long-term care cases in states that report residents and staff separately, residents make up 99 percent of COVID-19 deaths.

It should come as no surprise to policymakers that recent spikes in COVID-19 cases across the country have spiralled through long-term care facilities, with 2,461 new deaths reported last week. We also know that reported deaths have typically lagged behind reported cases in US COVID-19 data by three to four weeks, meaning that the deaths reported now are likely the result of cases reported weeks earlier. About 35 percent of the nation’s long-term care deaths reported last week occurred in the Midwest, which is home to 21 percent of the country’s population. For the second week in a row, Texas reported 10 percent of the week’s long-term care deaths.

Bad signs in the Midwest

The Midwest is now the epicenter of COVID-19 outbreaks in long-term care facilities. The region reported 38 percent of the nation’s cases last week, with states that reported new data averaging a 12 percent increase in cases. Iowa and North Dakota did not provide cumulative data last week, and Missouri doesn’t report cumulative data at all, so we don’t know for sure how residents in those long-term care facilities there are faring. Each of the remaining nine states in the Midwest region is seeing cases rise across their facilities.

Ohio’s reported the largest increase across the nation, representing 10 percent of all new long-term care cases. The state reported 1,845 new resident cases last week, Ohio’s highest since late May. On the other side of the region, South Dakota recorded its third week in a row with 200 or more new long-term care resident cases. Nebraska reported an 18 percent rise in long-term care resident cases. There were twice as many new cases reported in Illinois as there were in the previous week: 1,932 cases, up from 838. And Kansas reported a new high in long-term care cases of 624—nearly double last week’s increase. 

Minnesota saw resident cases spike by 14 percent this past week, and there were 144 new deaths. Both rises marked new peaks for Minnesota. To this day, Minnesota has maintained one of the highest rates of long-term care deaths compared to total number of deaths. In early May, Minnesota was reporting that around 80 percent of all the state’s COVID-19 deaths had occurred in long-term care facilities; today that figure is 69 percent. As case numbers in these communities continue to grow, we will be closely watching Minnesota’s long-term care death rate to see if the state has improved its ability to protect its most vulnerable residents. So far, the numbers are not encouraging. 

Additionally, Michigan reported 818 new deaths in long-term care facilities. Iowa reported a recent high of 47 new deaths. North Dakota experienced a near 20 percent increase in resident and staff deaths. 

Any surge in resident cases sends one message loud and clear—eight months into the pandemic, the federal government, states, and long-term care facilities are continuing to fail the population most vulnerable to COVID-19.


Artis Curiskis is outreach & reporting co-lead at the COVID Tracking Project and collaboratively runs the CTP special projects Long-Term Care COVID Tracker and City Data.


Erin Kissane is a co-founder of the COVID Tracking Project, and the project’s managing editor.


Kara Oehler is outreach & reporting co-lead at the COVID Tracking Project and collaboratively runs the CTP special projects Long-Term Care COVID Tracker and City Data.

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Aarushi Sahejpal is a Shift Lead on Long-Term Care and City Data at the COVID Tracking Project. She also studies International Relations & Data Science at American University

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Jessica Malaty Rivera has an MS in Emerging Infectious Diseases and is the Science Communication Lead at The COVID Tracking Project.


Sara Simon works on The COVID Tracking Project’s data quality team and is also a contributing writer. She most recently worked as an investigative data reporter at Spotlight PA and software engineer at The New York Times.


Peter Walker is Head of Marketing & Growth at PublicRelay and Data Viz Co-Lead at The COVID Tracking Project.


More “Long-Term Care” posts

Vaccines Begin to Arrive as Cases and Deaths Keep Rising: This Week in Long-Term Care COVID-19 Data, Dec 16

Cases are up and known deaths in long-term-care facilities are the highest they’ve been since late May.

What We Know—and What We Don’t Know—About the Impact of the Pandemic on Our Most Vulnerable Community

Residents of nursing homes and other long-term-care facilities suffered an outsized impact from COVID-19. And yet we still don’t know how big of an impact, because so much data is missing or incomplete. What we do know makes plain that we failed to protect this community—and at great cost.

Giving Thanks and Looking Ahead: Our Data Collection Work Is Done

While our work to compile COVID-19 data has concluded, we will continue to share research, analysis, and documentation in the months ahead. We are enormously grateful to the hundreds of volunteers who made this work possible.

By Erin Kissane & Alexis MadrigalMarch 8, 2021