Abstract
During the initial year of the COVID-19 pandemic, a disproportionate share of COVID-19-related deaths occurred among nursing home residents. Initial estimates of all-cause mortality rates also spiked in early and late 2020 before falling to near or below historical rates by early 2021. During the first 3 years of the pandemic, the US nursing home resident population also decreased by 18% (239 000 fewer residents) compared with pre-pandemic levels. After accounting for these population changes, the all-cause nursing home mortality rate has remained above pre-pandemic levels through the middle of 2023. The peak was in December 2020 at 5692 deaths per 100 000 residents, which was 19% higher than estimates not accounting for the population decrease.