Daisy-Daisy/iStockBy LAURA ROMERO, HALLEY FREGER, ALLISON PECORIN and SOO RIN KIM, ABC News

(NEW YORK) -- Even as death rates from the novel coronavirus have declined overall, nursing homes in the U.S. have persisted as one of the deadliest environments in the pandemic, according to a new ABC News analysis of the latest public health data.

"Nursing home residents remain at risk," said Dr. Jay Bhatt, an internist in Chicago and ABC News contributor, citing seniors' unique vulnerabilities to COVID-19 and a "broken and patchwork system of care delivery."

Since March, long-term care facilities across the nation have been ravaged by the coronavirus and have accounted for roughly 40% of virus-related deaths, data shows. Nursing home residents have taken steps to try and halt the spread by closing doors to loved ones, eliminating group activities and implementing strict protocols to isolate themselves.

Nationally, coronavirus infections have not been leading to deaths as frequently as they did earlier in the outbreak, according to public health data. While July had by far the most cases, the deadliest month of the outbreak was in April. According to the COVID Tracking Project, in April there were nearly 54,000 deaths while in July, there were 25,295 deaths.

ABC News conducted an analysis of state-by-state reporting of positive cases and deaths in America's nursing homes. And more than six months into the effort to fight the outbreak, those numbers show the virus continues to find pathways into nursing homes, accounting for at least 63,000 of the nation's more than 162,000 total coronavirus deaths.

Once the virus enters a nursing home, the percentage of positive cases that will lead to death has declined only slightly, from 21% to 18%. And in some states where the virus has slowed among the broader public, the cases have continued to climb in nursing homes, data from state health departments show.

In New Hampshire, for instance, where nursing homes accounted for 57% of deaths back in late May, they now account for 82% of total deaths. Similarly in Kentucky, where nursing home fatalities accounted for 56% of deaths in late May, they now make up 63% of those who succumbed to the disease. In Indiana and Ohio, where the percentage neared 50% back in May, the numbers have crept up to 54% of total deaths in August.

Connecticut, Delaware, Maine, Massachusetts, Minnesota, North Dakota, Pennsylvania and Rhode Island all continue to show significant death tolls in nursing homes, even as the overall number of fatalities has declined -- with the facilities accounting for more than 60% of each state's total number of deadly cases.

Bhatt said younger patients are surviving better as health care facilities are getting smarter about how they care for people stricken by the virus. But those advances have not extended as easily in nursing homes because, he added, of the vulnerabilities that make older adults especially susceptible targets -- such as weakened immune systems and other health complications.

As the number of fatalities in nursing homes continues to remain high, multiple efforts are underway to protect nursing home residents. In mid-July, the federal government announced it would send rapid testing kits for COVID-19 to all skilled nursing facilities in the country. So far, tests have been delivered to 1,500 locations, federal officials told ABC News.

But the new testing initiative has raised concerns among advocates and nursing homes about the accuracy and cost of the tests.

"To me, the accuracy is just so essential," said Richard Mollot, the executive director of the Long Term Care Community Coalition, an organization that advocates for nursing home residents. "If you don't have an accurate test then we're kind of wasting people's time and resources."

LeadingAge, an association of nonprofit providers of aging services that includes many nursing homes, recently sent a letter to Adm. Brett Giroir, the assistant secretary for health at the Department of Health and Human Services, which pointed out that while antigen testing is useful for rapid results, the tests have a 20% false-negative result. LeadingAge also estimated that weekly costs for facilities with 100 employees would be nearly $20,000. They did not provide underlying figures.

According to the Department of Health and Human Services (HHS), each nursing home in the U.S. will receive one diagnostic test instrument and associated antigen tests. Following initial distribution, nursing homes will be able to purchase additional tests directly from the manufacturer.

"When our nursing home receives the rapid test kits, we're responsible for paying for the tests," said Matthew Solomon, a spokesperson for Aviva, a nursing home in Florida. "Right now normal COVID-19 tests are costing us about $100 per test. And we have 300 residents so how are we going to pay for that?"

Solomon said his nursing home had its first positive coronavirus case about two weeks ago and ran out of federal stimulus aid on July 31.

The $2 trillion coronavirus relief packaged passed by Congress in March created mechanisms by which nursing homes could receive federal aid to help them combat the virus and keep employees on the payroll. In late July, HHS expanded the application window for some Medicaid and Medicare-funded facilities to apply for additional aid, but Solomon said his facility is no longer receiving federal support.

Congress, after weeks of debate, has so far failed to pass additional coronavirus relief legislation after weeks of partisan in-fighting. Failure to pass additional legislation means funding for many programs, including those providing support to nursing facilities, will soon dry up entirely. In a Facebook Live event with NBC last week, Giroir acknowledged the tests being distributed to nursing homes are not as accurate as other tests but return results faster, which he said is a key tool to help quickly identify hot spots.

"It is much better to have a much less sensitive test that you get back within 15 minutes than a perfectly sensitive test you get back in three days," Giroir said.

Gail Bruno, a certified nursing assistant at a nursing home in South Florida that has seen a recent increase in coronavirus cases, says long-term care facilities did not receive access to testing or vital protective equipment fast enough.

"I'm tired, it's been months," Bruno said. "We have 23 residents who are positive right now and it is very, very scary."

In late July, the Department of Health and Human Services announced it would distribute $5 billion to nursing homes through the CARES Act Provider Relief Fund for Nursing Homes.

On Friday, the agency announced its plans to allocate these funds through an initial $2.5 billion distributed to nursing homes in mid-August to support increased testing, staffing, PPE needs, and COVID-19 isolation facilities. This will be followed by additional performance-based distributions throughout the fall that "will consider the prevalence of the virus in the nursing home's local geography, and will be based on the nursing home's ability within this context to minimize COVID spread and COVID-related fatalities among its residents," according to HHS.

For nursing home advocates like Toby Edelman, a senior policy attorney for the Center for Medicare Advocacy, the latest figures showing the persistence of the virus in nursing homes serve as a reminder of the challenges the facilities will continue to face.

"Nursing facilities do not have enough staff, tests, and personal protective equipment," Edelman said, adding that as a result, they "remain dangerous places, for residents and workers alike."

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