Long-Term Care Report: Nursing Homes Most Affected by COVID-19

People in need of care and staff in nursing homes were hardest hit during the coronavirus pandemic. This is the conclusion of this year’s Long-Term Care Report, drawn up by a team of authors at SOCIUM Research Center on Inequality and Social Policy, commissioned by BARMER health insurance.

Today (Tuesday, November 29, 2022), this year’s BARMER Long-Term Care Report was presented in Berlin. It illustrated the impact of COVID-19 on people in need of care and staff in nursing homes.

The authors, health economists Professor Heinz Rothgang and Dr. Rolf Müller, scientifically evaluated the long-term care statistics and routine data collected by BARMER for the latest report. Their evaluation included in-depth studies on case numbers, incidence, prevalence, and care progression.

The bottom line: over 50% of those who died of COVID-19 in the first two waves were nursing home residents. In the first two waves, the incidence of illness-related workplace absences due to COVID-19 was four to five times higher for nursing home personnel than for other occupational groups in other sectors. What is important for policymakers is how the COVID-19 pandemic was tackled, what the consequences were, and how it should be tackled in the future. The drastically restrictive measures from the first two waves of COVID-19 are currently no longer considered appropriate. As a result, residential services were used to a lesser extent, although demand can be assumed to continue. In addition, the nursing homes were subject to additional financial burdens and reduced income. The long-term care insurance covered these costs, but is still waiting for full refinancing  by the state budget – as was promised in the coalition treaty.

People in Nursing Homes Hardest Hit

In order to limit the spread of the infection, nursing homes implemented drastic measures to minimize contact. Nevertheless, 2.2% of those in need of full-time residential care were diagnosed with COVID-19 in May 2020 and 8.3% in November 2020, and were thus affected around seven times as much as the population as a whole in the first two waves. In the fourth wave at the end of 2021, the prevalence was around 4%, roughly twice as high as in the general population.

According to projections based on BARMER data, the peaks of the first and second wave of COVID-19 resulted in 3,970 COVID-19 deaths in April 2020 and 21,677 COVID-19 deaths in December 2020. Of these, 61% were nursing home residents. The last peak between 2020 and 2021 was in December 2021, with 11,391 COVID-19 deaths. Of these, some 30.3% are nursing home residents. There was an excess mortality of people in nursing homes, especially during the second and fourth waves of the pandemic. In 2020 and 2021, a total of 155,000 more nursing home residents died than would be expected from the mortality rates from 2017 to 2019.

Long-Term Care Staff Are Primary Bearers of Responsibility and Care

In April 2020, more than 2 out of 1,000 (geriatric) nurses in nursing homes were diagnosed with COVID-19, around 5 out of 1,000 in December 2020, and just under 3 out of 1,000 in November 2021. As a result, absenteeism rates in the first two waves were about five times higher than for employees in other occupations and sectors. In the fourth wave, the differences between occupational groups and sectors were minimized, with (geriatric) nurses no longer impacted to a greater extent than other occupational groups.

Caution Exercised in the First Two Waves Paves Way for Some Normalization

In the first two waves, fear of infection was an important factor in deciding against the use of long-term care services or nursing homes among those in need of long-term care and their families. In addition, the increased staff shortages due to sick leave reduced service provision capacities. After the approval of the vaccines and the vaccination campaign in nursing homes, the picture changed: The use of residential care revived and by the end of 2021 reached roughly the same level as before the coronavirus pandemic.
Extra Expenditures of Long-term Care Insurance Were Not Fully Compensated by State Subsidies

The authors of the study criticize that the coalition agreement promises of financing the additional costs of long-term care insurance due to the pandemic from tax resources have been broken. In fact, the additional costs of 9.2 billion euros accrued up to the end of the first quarter of 2022 will only be offset by tax-financed federal subsidies of 4 billion euros by the end of 2022. This means that a sum of 5.2 billion euros will still need to be borne by long-term care insurance.

Learning from the Crisis

“Currently, the population no longer perceives COVID-19 as being as risky, and long-term care does not seem to be affected as much as it was in the first two waves,” says Professor Rothgang. “Nevertheless, there are still higher infection and mortality rates among those in need of long-term care. Therefore, protective measures should not be completely dispensed with.” Since it is unpredictable whether further virus variants will prevail and potentially lead to severe progression, he firmly believes that appropriate preparations should be made should such a situation arise.

Further Information:

BARMER Care Report:

Rothgang Statement:

Rothgang Presentation:


Professor Heinz Rothgang
SOCIUM Research Center on Inequality and Social Policy
Tel.: +49 421 218-58557
Email: rothgangprotect me ?!uni-bremenprotect me ?!.de

Dr. Rolf Müller
SOCIUM Research Center on Inequality and Social Policy
Tel.: +49 421 218-58554
Email: rmintprotect me ?!uni-bremenprotect me ?!.de

Nurse sitting on a hospital bed next to an older woman helping hands.
People in need of care and staff in facilities were hardest hit during the coronavirus pandemic. This is the conclusion of this year’s nursing report of the SOCIUM Research Center on Inequality and Social Policy at the University of Bremen, which was commissioned by BARMER Krankenkasse