This article discusses that across the US, nursing homes are reporting a high number of COVID-19 deaths among residents. As of May 21, 2020, at least 35,000 COVID-19 deaths in the US were of nursing home or long-term care facility residents. These deaths contribute to 42% of COVID-19 deaths in the 38 states included in this data pool.

Methods

Using publicly available data from state departments of health, researchers created a database of nursing homes with COVID-19 cases as of May 11, 2020. This data was linked to Nursing Home Compare and other data sources to pull together the following information: NH size (number of beds), ownership (for-profit, nonprofit, government), chain membership, high Medicaid share, high percentage of African American residents (>25%), urban location, CMS overall five-star rating, prior infection violation, and state.

Data analysis: logistic regression to estimate the odds ratio of each characteristic having COVID-19, linear regression of 21 states reporting case counts to estimate the relationship between facility characteristics and outbreak size.

Results

• 9,395 nursing homes in the sample, 2,949 (31.4%) had a documented case of COVID-19
• In facilities with COVID-19, the average number of cases was ~20, outbreak size ranged from 1-256 cases
• Large facility size, urban location, larger percentage of African American residents, non-chain status, and state were significantly (p<.05) positively correlated to having a COVID-19 case
• Outbreak size was significantly associated with smaller facility size, for-profit status, and state
• Five-star rating, prior infection violation, Medicaid dependency, and ownership were not significantly related

Discussion

COVID-19 outbreaks are more related to facility size and location, rather than traditional quality metrics (star rating, infection control citations). The finding that facilities with a higher percentage of African American residents are more likely to have cases is consistent with the disparities that have been described in the pandemic for the overall population. The negative relationship between outbreak and facility size show that while smaller facilities are less likely to have outbreaks, their outbreaks affect more patients-per-bed. This may be due to smaller facilities having more bed turnover and difficulty isolating patients due to space limitations. The authors conclude that the rapid changing and high mortality of COVID-19 outbreaks in nursing homes indicate the need for continued visitor restrictions, increased testing of staff and residents, and increased infection control protocols, including more access to PPE.

Limitations: tracking and reporting variations between states, lack of national reporting at the time of the article, sample size, shorter timeframe of data

This article review was approved by Dr. Kathleen Unroe, IU School of Medicine associate professor, geriatrician, and IU Center for Aging Research Scientist.