Factors Associated with Increase in COVID-19 Cases in Nursing Homes: A Study of Nursing Homes in Midwestern States

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Background: The COVID-19 pandemic disproportionately affects older adults, especially, those in nursing homes (NHs) with over 27% of deaths attributed to COVID-19. However, some nursing homes fare better than others. This study examined the following factors: nursing home ratings, quality of care, staff shortage, PPE shortage, and ownership status to understand the association between them and COVID-19 cases.

Methods: Three datasets were combined from Centers for Medicare & Medicaid Services (CMS): 1. Star rating; 2. Provider information and 3. COVID-19 nursing home. The time period examined is from Jan 1 – Oct 25, 2020 for the 12 Midwestern states in the population set. There were 4525 free-standing NHs for the analysis after removing cases with missing values. The measures used were self-reported information on ratings, quality of care, staff shortages, PPE shortage, occupancy rate and ownership. Ordinal logistic regression was used to examine the association between nursing home ratings on health inspections, quality measures, and staffing domains with COVID-19 cases.

Results: Of the 4525 NHs in 12 Midwestern states, high performing NHs were less likely to have more than 30 COVID-19 cases than were low-performing facilities for two of the CMS domain (health inspections, 179 [11.6%] vs 542 [18.2%]; and staffing 175 [9.1%] vs 546 [20%]). There was also statistically significant association between high- vs low-performing NHs in overall rating and COVID19 cases and a statistically significant association between NH ownership, occupancy rate, RN, LPN and CNA staffing in NHs having ≤10 CV cases vs 11-30 CV cases vs >30 CV cases (all p ≤ 0.01).

Conclusions: Our findings show a statistically significant association between ownership and COVID-19 cases among residents. Of the NHs that had more than 30 COVID-19 cases, 70.2% were for-profit nursing homes, 5.9% were government owned and 23.9% were non-profit. There was no statistically significant association between PPE shortages and COVID-19 cases. Finally, there was a significant negative association between RN and CNA staffing i.e. more staffing hours of RNs and CNA correlated with fewer number of COVID-19 cases.