Current Impact of COVID-19 in Long-Term Care Facilities in the United States: A Systematic Literature Review

Background: COVID-19 disproportionately affects older adults, placing residents of closed-community settings, such as long-term care facilities (LTCFs), at increased risk for severe illness and death. Objective: To describe the epidemiology and healthcare resource utilization associated with acute COVID-19 in LTCFs in the United States during Omicron variant predominance. Data Sources: MEDLINE and Embase databases were searched on January 15, 2025 for full-text citations published on or after January 1, 2022. Conference abstracts from long-term care conferences in 2023 and 2024 were hand-searched. Records were included if they described acute COVID-19 in LTCFs (nursing homes, assisted living facilities, or Veterans Affairs Community Living Centers). Records were excluded if they were conducted outside the United States, published in languages other than English, focused on long COVID, did not include data from the Omicron predominance period (beginning November 1, 2021), or were clinical trials, case reports/case series, narrative reviews, editorials, or commentaries. Data Synthesis: Forty-three articles met the inclusion criteria, most of which reported COVID-19 cases (20 studies), mortality (18 studies), and/or healthcare resource utilization (11 studies). Although all studies included COVID-19 data during the Omicron period, most also included earlier periods during which other COVID-19 variants were predominant. In the United States, weekly incidence rates for COVID-19 infections and hospitalizations among nursing home residents ranged from 614 to 1338 and from 38 to 71 per 1,000 residents, respectively. Approximately 1 in 6 COVID-19 hospitalizations occurred among LTCF residents. Compared with community-dwelling individuals, mortality was 4.6-fold higher among LTCF residents. Conclusion: COVID-19 in LTCFs was associated with high rates of hospitalization and mortality among residents, including vaccinated individuals, during the study period.