Nursing home residents are highly susceptible to COVID-19 infection and complications. We used a generalized linear mixed Poisson model and spatial statistics to examine the determinants of COVID-19 deaths in 13,350 nursing homes in the first 2-year pandemic period using the Centers for Medicare and Medicaid Services and county-level related data. The average prevalence of COVID-19 mortality among residents was 9.02 (Interquartile range = 10.18) per 100 nursing home beds in the first 2-year of the pandemic. Fully-adjusted mixed model shows that nursing homes COVID-19 deaths reduced by 5% (Q2 versus Q1: IRR = 0.949, 95% CI 0.901– 0.999), 14.4% (Q3 versus Q1: IRR = 0.815, 95% CI 0.718 – 0.926), and 25% (Q2 versus Q1: IRR = 0.751, 95% CI 0.701– 0.805) of facility ratings. Spatial analysis showed a significant hotspot of nursing home COVID-19 deaths in the Northeast US.