Assisted Living Communities With These Characteristics Tend to Have More Covid-19 Cases

Assisted living communities tend to have more Covid-19 cases if they serve older residents, people with certain diagnoses, or a larger proportion of people from minority demographic groups.

These are among the findings from researchers out of the University of Rochester, who analyzed seven states’ publicly available data on Covid-19 infections in assisted living. The findings are being published in the Journal of the American Geriatrics Society.

The analytical sample for the study consisted of 3,994 assisted living communities in Colorado, Connecticut, New York, Georgia, Ohio, North Carolina and South Carolina. These communities logged 2,542 Covid-19 cases and 675 deaths.


These states are not only a small proportion of the country as a whole, but the data were not consistent across these states. For example, New York reported Covid-19 deaths in assisted living but not the total number of cases, while Ohio reported cases but not deaths.

“To date, almost nothing is known about the impact of Covid-19 on the AL population,” the researchers wrote. They noted that their findings may not be generalizable given the size of the study, and they also emphasized the need for more uniformity both in the data collection standards and the level of government attention and support of assisted living.

Across the seven states considered in the study, Covid-19 case fatality rate was 7.24% through the end of May, with the fatality rate in assisted living being about four times higher than the rate in the surrounding county as a whole.


However, the virus exacted a far steeper toll in some states than others. The Northeast was an early hotbed of the pandemic in the United States, as reflected in Connecticut’s overall fatality rate of 9.26% and assisted living fatality rate of 31.59% through the end of May. That compares to an overall fatality rate of 3.32% and an assisted living fatality rate of 12.89% in North Carolina.

An assisted living community is more likely to have at least one resident case of Covid-19 if that community has a higher average resident age, the researchers found. Very small assisted living communities, with nine or fewer residents, were “considerably” less likely to have at least one case than mid-size or large communities.

If an assisted living community has at least one resident case of Covid-19, several factors are associated with having a higher count of cases. Mid-size communities of 9 to 29 residents had fewer cases than very small or larger communities, which were not statistically different in this regard. Communities that served a higher proportion of residents with dementia, cardiopulmonary obstructive disease (COPD) and obesity also were more likely to have more Covid-19 cases. And, serving a higher proportion of Black and Hispanic residents was associated with having a higher number of Covid-19 cases, but not a higher number of deaths.

The research team conducted a separate study of Covid-19 in nursing homes, and found predicted counts of cases and deaths were two to four times higher for facilities with the highest proportions of residents from underrepresented racial/ethnic backgrounds.

“Nursing home staff from these communities — especially staff of color who make up over 50 percent of nursing home direct care workforces — are more likely to live in crowded households and neighborhoods, travel to and from work by public transportation, and be low paid with few or no benefits such as paid sick leave, ‘all placing them at higher risks of COVID-19 infection as well as inadvertent cross-infection with patients,’” the University of Rochester wrote, in announcing the findings.

Despite similarities in the vulnerability of their resident and patient populations, nursing homes have received more federal oversight and more government support than assisted living communities during the pandemic. These findings show that greater support is needed for assisted living, the researchers believe.

“Relying on AL communities to muster a rigorous response to the Covid-19 pandemic largely on their own is clearly unrealistic,” they wrote. “ALs and their residents urgently need local, state, and the federal governments to pay at least the same level of attention as that given to nursing homes.”

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