USA Today Investigation Finds Midwestern Nursing Home Chain Reported a COVID-19 Death Rate Double the National Average

A recent USA Today investigation identified one Midwest nursing-home chain reported more than double the COVID-19 death rate during last winter’s surge compared to the national average.

Owned by a for-profit real estate investment firm, Trilogy Health Services operates 115 nursing home facilities spanning four Midwestern states: Indiana, Kentucky, Michigan, and Ohio.

Trilogy’s parent company — American Healthcare Real Estate Investment Trust (REIT) — bills itself as an historic opportunity for stock-market investors, boasting over $4.2 Billion in assets, including 312 healthcare properties.

According to USA Today, while Trilogy’s real-estate venture promises shareholders the investment opportunity of a lifetime, what it actually delivered was the highest death rates among any large nursing home chain in the United States.

Hundreds of Trilogy Residents Die From COVID-19

During the height of the pandemic's winter 2021 surge, roughly 3.3 residents for every 1,000 died each week in U.S. nursing homes. By comparison, Trilogy’s initial reports showed 7 residents for every 1,000 died in their facilities each week.

Adapting a resource from the U.S. Health Resources and Services Administration (HRSA), which tracks and assesses how well nursing home facilities addressed COVID-19 infections and deaths, USA Today investigators found Trilogy’s nursing-home death rate stood out on a national scale.

In fact, USA Today found 47 of Trilogy Health Service facilities reported death rates more than double that of the national average.

Roughly 45.7% of Trilogy’s nursing homes had a death rate that was twice the national average, compared to 15.2% of other large nursing-home chain operators.

Among all the data compiled by USA Today, Trilogy also stood out for how many of its patients died once they were infected with COVID-19. In total, Trilogy reported 772 COVID-19 deaths in winter 2021 — a number they have since revised after the publication of USA Today’s report.

Investigations into Trilogy-owned nursing homes found the facilities had been cited by state health inspectors for violations on numerous occasions.

Trilogy nursing homes were cited for the following violations:

  • Improper disposal of used gowns, gloves, and masks in entryway trash cans
  • Failure to wipe down and properly sanitize equipment
  • Failure to enforce proper hand-cleaning among employees
  • Failure to enforce employees’ requirement to change gowns to reduce likelihood of infection
  • Failure to close the doors of COVID-19-patient rooms
  • Failure to wear gloves when touching/making contact with nursing home residents

Trilogy responded to USA Today’s investigation by stating it had reported hundreds of COVID-19 deaths during the pandemic’s 2021 winter surge by mistake. The company then presented USA Today with a revised figure — reducing its overall death toll by more than 40% — but has yet to include evidence to support their claim.

Budget and Staff Cuts During the COVID-19 Pandemic

According to the U.S. Centers for Medicare and Medicaid Services (CMS), COVID-19 was a contributing factor in at least 151,191 nursing-home resident deaths. Of these, roughly half came during the winter surge between October 2020 and February 2021, when a total of 71,000 residents died across the United States.

Factors like insufficient training, poor working conditions, and crisis-level nursing home staffing shortages have all contributed to the rising number of deaths in nursing homes around the country.

In addition, many nursing home chains are constantly seeking ways to maximize profits and reduce the costs of caring for individual patients. To this end, some chains look to cut staff, which accounts for roughly half of the total operating budget for most nursing homes.

In an interview with USA Today, Assistant Professor of Health Economics at Cornell University Tyler Braun, commented on staff cuts at nursing homes, saying: “It is ultimately going to have effects on patient care and quality.”

At Trilogy-owned nursing homes, tight budgets and staffing cuts were the norm. In its investigation of Trilogy expense reports, USA Today discovered the number of paid working hours per patient decreased by 13% over four years. Meanwhile, the federal average was just 2% during the same period.

The number of certified nursing assistants (CNAs) also fell at Trilogy-owned facilities, ranking among the lowest of major nursing home chains. CNAs play a vital role in nursing homes by making sure each resident is fed, bathed, changed, and brought to the bathroom.

During the pandemic, CNAs have experienced a growing list of responsibilities — often assisting patients who are sick or infected by COVID-19 while attempting to adhere to new safety requirements aimed at preventing infection and spread.

Professor Charlene Harrington of the University of California San Francisco described CNAs as “the foundation” of the nursing-home industry. Facing the conditions of a staffing crisis, however, Harrington said, “the work just doesn’t get done — it’s impossible.”

Nursing Home Abuse During the Pandemic

Data from the U.S. Bureau of Labor Statistics shows the nursing home industry has lost over 420,000 jobs since the pandemic began in 2019. As the elderly population continues to grow — and the U.S. Department of Health and Human Services expects it to double by 2040 — nursing homes have an increasing need for skilled workers.

According to CMS, one of the best indicators for nursing home quality is a facility’s staff-to-patient ratio. More and more, the depletion of nursing home staff — whether from budget cuts, poor working conditions, low wages, burnout, or a combination of these factors — contributes to the conditions that make nursing homes a breeding ground for elder abuse.

Sadly, in the United States, 1 in 10 adults 60-years-old or older are victims of nursing home abuse — a figure many experts believe is underestimated.

Nursing home abuse can include:

  • Physical abuse, which comes in many forms from beating to restraining
  • Severe neglect, leading to health issues like untreated bedsores, malnutrition, over- or under-medication, and injuries from falls
  • Sexual abuse, a widespread problem reported to authorities in only 30% of cases

That’s why it’s increasingly important to know the warning signs of nursing home abuse and neglect: physical injuries, poor hygiene, malnourishment, and sudden emotional or personality changes, among others.

Be ready to report them to the authorities or to your local ombudsman.

If you suspect or find out someone you love has been a victim of nursing home abuse, don’t wait — get experienced legal help right away.

Sokolove Law Team

Contributing Authors

The Sokolove Law Content Team is made up of writers, editors, and journalists. We work with case managers and attorneys to keep site information up to date and accurate. Our site has a wealth of resources available for victims of wrongdoing and their families.

Last modified: March 18, 2022

  1. Center for Medicare and Medicaid Services (CMS). “COVID-19 Nursing Home Data: Information on COVID-19 reported by nursing homes to the CDC’s National Healthcare Safety Network (NHSN) COVID-19 Long Term Care Facility Module.” CMS, 27 Feb. 2022. Retrieved March 12, 2022, from 
  2. Fraser, Jayme. “Dying for Care: How we did it: Read about the data-driven work behind USA TODAY’s nursing home project.” USA Today, 10 March 2022. Retrieved March 12, 2022, from
  3. Stein, Letitia, et al. “This Nursing Home Chain Stood Out for Nationally High Death Rates as Pandemic Peaked.” USA Today, 10 March 2022. Retrieved March 12, 2022, from 
  4. U.S. Health Resources and Services Administration (HRSA). “Nursing Home Quality Incentive Program Methodology.” HRSA, 21 Sept. 2021. Retrieved March 2022, from