Interpreting COVID-19 deaths among nursing home residents in the US: The changing role of facility quality over time

PLoS One. 2021 Sep 1;16(9):e0256767. doi: 10.1371/journal.pone.0256767. eCollection 2021.

Abstract

A report published last year by the Centers for Medicare & Medicaid Services (CMS) highlighted that COVID-19 case counts are more likely to be high in lower quality nursing homes than in higher quality ones. Since then, multiple studies have examined this association with a handful also exploring the role of facility quality in explaining resident deaths from the virus. Despite this wide interest, no previous study has investigated how the relation between quality and COVID-19 mortality among nursing home residents may have changed, if at all, over the progression of the pandemic. This understanding is indeed lacking given that prior studies are either cross-sectional or are analyses limited to one specific state or region of the country. To address this gap, we analyzed changes in nursing home resident deaths across the US between June 1, 2020 and January 31, 2021 (n = 12,415 nursing homes X 8 months) using both descriptive and multivariable statistics. We merged publicly available data from multiple federal agencies with mortality rate (per 100,000 residents) as the outcome and CMS 5-star quality rating as the primary explanatory variable of interest. Covariates, based on the prior literature, consisted of both facility- and community-level characteristics. Findings from our secondary analysis provide robust evidence of the association between nursing home quality and resident deaths due to the virus diminishing over time. In connection, we discuss plausible reasons, especially duration of staff shortages, that over time might have played a critical role in driving the quality-mortality convergence across nursing homes in the US.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • COVID-19 / mortality*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Nursing Homes*
  • Pandemics*
  • Quality of Health Care*
  • SARS-CoV-2*
  • United States / epidemiology

Grants and funding

The authors acknowledge that there are no financial disclosures to provide. One of the study coauthors (SCT) is affiliated with the Fors MarshGroup (FMG), Arlington, VA. However, FMG did not play any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Neither did FMG provide any financial support in the form of the coauthor’s salary and/or research materials. The coauthor affiliated with the FMG undertook work for this study in the role of an independent researcher working specifically and only during weekend hours outside of his employment with FMG.