COVID-19 Pandemic in Assisted Living Communities: Results from Seven States

J Am Geriatr Soc. 2020 Dec;68(12):2727-2734. doi: 10.1111/jgs.16850. Epub 2020 Oct 7.


Objective: To describe variations in COVID-19 confirmed cases and deaths among assisted living (AL) residents and examine their associations with key AL characteristics.

Design: Observational study employing data on confirmed COVID-19 cases and deaths in ALs from seven states, through May 29, 2020.

Setting: Information on COVID-19 cases/deaths in ALs was obtained from state government websites. A national inventory of ALs was used to identify communities with and without COVID-19 cases/deaths. Medicare Beneficiary Summary File identifying AL residents was employed to develop AL characteristics. County-level COVID-19 laboratory-confirmed cases/deaths were obtained from publicly available data.

Participants: We found 4,865 ALs (2,647 COVID-19 cases and 777 deaths) in the seven states. After excluding missing data, the sample consisted of 3,994 ALs (82.1%) with 2,542 cases (96.0%) and 675 deaths (86.9%).

Main outcomes and measures: Outcomes were AL-level counts of cases and deaths. Covariates were AL characteristics and county-level confirmed COVID-19 cases/deaths. Multivariable two-part models determined the associations of independent variables with the likelihood of at least one case and death in the AL, and with the count of cases (deaths).

Results: State case fatality ranged from 3.32% in North Carolina to 9.26% in Connecticut, but for ALs in these states it was 12.89% and 31.59%, respectively. Among ALs with at least one case, midsize communities had fewer cases (incidence rate ratio (IRR) = 0.829; P = .004) than small ALs. ALs with higher proportions of racial/ethnic minorities had more COVID-19 cases (IRR = 1.08; P < .001), as did communities with higher proportions of residents with dementia, chronic obstructive pulmonary disease, and obesity.

Conclusions and relevance: ALs with a higher proportion of minorities had more COVID-19 cases. Many of the previously identified individual risk factors are also present in this vulnerable population. The impact of COVID-19 on ALs is as critical as that on nursing homes, and is worth equal attention from policy makers.

Keywords: COVID-19; assisted living; risk factors.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Assisted Living Facilities / statistics & numerical data*
  • COVID-19* / diagnosis
  • COVID-19* / mortality
  • Comorbidity
  • Ethnicity
  • Female
  • Health Facility Size
  • Homes for the Aged / statistics & numerical data
  • Humans
  • Male
  • Medicare / statistics & numerical data*
  • Nursing Homes / statistics & numerical data*
  • Risk Assessment / methods*
  • Risk Factors
  • SARS-CoV-2 / isolation & purification
  • United States / epidemiology
  • Vulnerable Populations