Residential Care Communities

Long-term Care and COVID-19

The NCHS National Post-acute and Long-term Care Study (NPALS) collects data on assisted living and similar residential care communities (RCCs) every two years for all 50 states and the District of Columbia. The goal is to monitor the diverse post-acute and long-term care sectors. The 2020 survey provided an opportunity to collect COVID-19-related data in this healthcare setting. These data are not available from other data systems. RCCs provide services in noninstitutional home-like settings and are staffed around the clock to provide supervision and assistance with personal care, such as bathing and medication management. Nursing homes provide 24-hour nursing care to individuals with greater medical needs. Data on COVID-19 in nursing homes are available here: https://www.cdc.gov/nhsn/covid19/ltc-report-overview.html.

The data shown in these figures are based on preliminary data collected for the 2020 NPALS beginning in November 2020 through March 2021. The data collected about RCC’s COVID-19 experiences, as reported by RCC directors/administrators in the questionnaire, are retrospective beginning from January 2020 through the questionnaire completion date. The latest response date in the preliminary data is March 25, 2021. The results are based on survey responses from 3,295 eligible RCCs from a sample of 11,618 RCCs and are weighted to be nationally representative. The data used in these figures are considered preliminary and the results may change after the release of the final 2020 NPALS data file, which will be updated in 2022. Data represent RCCs and not individuals. For more details about the RCC preliminary data see Technical Notes and for more information about NPALS, please visit https://www.cdc.gov/nchs/npals/about_npals.htm.

Long-term Care Settings

Figure 1: Number of COVID-19 cases, hospitalizations, and deaths among residential care community residents and staff since January 2020 through March 2021

This figure shows the number of presumptive positive or confirmed COVID-19 cases, hospitalizations, and deaths reported by RCCs from January 2020 through March 2021, grouped by U.S. Census region and metropolitan statistical areas. Data are presented for both residents and staff separately.

  • COVID-19 Cases are reported by directors/administrators and include cases that are either presumptive positive or confirmed by testing.
  • Hospitalizations and Deaths due to COVID-19 are reported by directors/administrators.
  • Resident includes any resident living in the RCC at any time since January 2020.
  • Staff includes direct employees and contractors at the RCC at any time since January 2020.
  • US Census Region is based on the U.S. Census definitionspdf iconexternal icon:
    • Northeast
    • Midwest
    • South
    • West
  • Metropolitan statistical areas are based on geographic entities delineated by the Office of Management and Budget (OMB)external icon:
    • Metropolitan: core urban area of 50,000 or more population
    • Nonmetropolitan: areas with less than 50,000 population

Figure 2: Number of COVID-19 cases since January 2020 through March 2021 among residential care community residents and staff, by community characteristics

This figure shows the number of presumptive positive or confirmed COVID-19 cases between January 2020 and March 2021 grouped by U.S. Census region and metropolitan statistical areas, according to five key characteristics of RCCs. Data are presented for both residents and staff separately.

  • COVID-19 Cases are reported by directors/administrators and include cases that are either presumptive positive or confirmed by testing.
  • Resident includes any resident living in the RCC at any time since January 2020.
  • Staff includes direct employees and contractors at the RCC at any time since January 2020.
  • US Census Region is based on the U.S. Census definitionspdf iconexternal icon:
    • Northeast
    • Midwest
    • South
    • West
  • Metropolitan statistical areas are based on geographic entities delineated by the Office of Management and Budget (OMB)external icon:
    • Metropolitan: core urban area of 50,000 or more population
    • Nonmetropolitan: areas with less than 50,000 population
  • RCC Size: small (1-25 users), medium (26-100 users), and large (101 or more)
  • Medicaid certification: whether an RCC is authorized or set up to participate in Medicaid
  • Chain affiliation: whether an RCC is owned by a person, group, or organization that owns/manages two or more RCCs, including corporate chains
  • Ownership type: whether an RCC is for profit (private or publicly traded/limited liability company) or nonprofit (including government)
  • Any PPE shortage: whether an RCC experienced a shortage of eye protection, gloves, face masks, isolation gowns, and N95 respirators at any time since January 2020

Figure 3: Percentage of residential care communities that experienced personal protective equipment shortages since January 2020 through March 2021

This figure shows the percentages of RCCs that experienced a shortage of personal protective equipment at any time since January 2020 and by four time periods (January 2020 through March 2020, April 2020 through June 2020, July 2020 through September 2020, and October 2020 through March 2021), grouped by U.S. Census region and metropolitan statistical areas.

  • Personal Protective Equipment Shortages displays “yes” response out of three options (yes, no, don’t know) during each time period included:
    • Eye protection, gloves, face masks, and isolation gowns
    • N95 respirators
  • US Census Region is based on the U.S. Census definitionspdf iconexternal icon:
    • Northeast
    • Midwest
    • South
    • West
  • Metropolitan statistical areas are based on geographic entities delineated by the Office of Management and Budget (OMB)external icon:
    • Metropolitan: core urban area of 50,000 or more population
    • Nonmetropolitan: areas with less than 50,000 population

Figure 4: Percentage of residential care communities with selected practices for the prevention, response, or management of COVID-19 infections since January 2020 through March 2021

This figure shows the percentages of RCCs with infection control practices in their prevention, response, or management of COVID-19 infections between January 2020 and March 2021, grouped by U.S. Census region and metropolitan statistical areas.

  • Infection control practices:
    • Screening residents daily for fever or respiratory symptoms
    • Notifying all residents or families of cases in the RCC with 24 hours
    • Use of telephone or audio-only calls to assess, diagnose, monitor, or treat residents with presumptive positive or confirmed COVID-19 infection
    • Use of telemedicine or telehealth (ie., audio with video, web videoconference) to assess, diagnose, monitor, or treat residents with presumptive positive or confirmed COVID-19 infection
    • Limiting of communal dining and recreational activities in common areas
  • US Census Region is based on the U.S. Census definitionspdf iconexternal icon:
    • Northeast
    • Midwest
    • South
    • West
  • Metropolitan statistical areas are based on geographic entities delineated by the Office of Management and Budget (OMBexternal icon):
    • Metropolitan: core urban area of 50,000 or more population
    • Nonmetropolitan: areas with less than 50,000 population

Figure 5: Percentage of residential care communities that imposed in-person restrictions since January 2020 through March 2021

This figure shows the percentages of RCCs with in-person restrictions on individuals from entering the building, grouped by U.S. Census region and metropolitan statistical areas.

  • In-person restrictions included five response options for never, sometimes or often, always, and don’t know for the following types of individuals:
    • Family and relatives
    • Visitors
    • Volunteers
    • Non-essential consultant personnel (e.g. barbers, delivery personnel)
  • US Census Region is based on the U.S. Census definitionpdf iconexternal icon:
    • Northeast
    • Midwest
    • South
    • West
  • Metropolitan statistical areas are based on geographic entities delineated by the Office of Management and Budget (OMB)external icon:
    • Metropolitan: core urban area of 50,000 or more population
    • Nonmetropolitan: areas with less than 50,000 population

Technical Notes

  • The preliminary data only includes survey submissions through mail and web who responded by March 25, 2021, excluding later mail and web submissions and all CATI survey mode respondents, which may introduce response bias and estimates may change once data are final.
  • Data are weighted and are nationally representative.
  • Cases with missing data are excluded on a variable-by-variable basis.
  • Data represent residential care communities, not individual residents.
  • To be eligible to participate in NPALS a RCC had to be licensed, registered, listed, certified, or otherwise regulated by the state; have four or more licensed, registered, or certified beds; provide room and board with at least two meals a day, around-the-clock on-site supervision, help with personal care, such as bathing and dressing or health related services such as medication management, and serve a predominantly adult population. RCCs licensed to exclusively serve the mentally ill or the intellectually disabled/developmentally disabled populations are excluded from NPALS.
  • All estimates shown meet the NCHS Data Presentation Standards for Proportions https://www.cdc.gov/nchs/data/series/sr_02/sr02_175.pdfpdf icon and meet NCHS confidentiality standards.

Data Source

The preliminary data presented are from National Center for Health Statistics’ 2020 National Post-acute and Long-term Care Study residential care community survey. For more details please visit https://www.cdc.gov/nchs/npals/about_npals.htm.

Page last reviewed: August 10, 2021