COVID-19 CASES AND DEATHS IN NURSING HOMES: ROLE OF QUALITY IN MULTIPLE WAVES

Abstract

Abstract The COVID-19 pandemic has disproportionally impacted nursing homes in the United States. As of February 2022, nursing homes have reported over 980,000 resident cases and nearly 150,000 resident deaths, accounting for a high share of total COVID-19 cases and deaths in the U.S. Earlier studies have identified various factors that relate to nursing homes’ vulnerability to COVID-19 (e.g., ownership status, facility size). Quality has a critical role in affecting nursing home COVID-19 outcomes. However, research on this topic has been relatively limited and inconsistent. Using publicly available data from CMS COVID-19 Nursing Home Dataset, Nursing Home Compare, Long-Term Care Focus, and The New York Times, this study examines the role of nursing home quality (e.g., infection control deficiency, quality of care deficiency, and five-star quality rating) on COVID-19 resident cases and deaths during multiple waves. Of the over 15,000 nursing homes examined, approximately 64% have had at least one infection control deficiency and 82% have had at least one quality of care deficiency during the two years preceding the COVID-19 pandemic. Results from regression models indicate that the likelihood of having at least one case is more related to facility and resident characteristics (e.g., facility size, percentage of Medicaid residents) and environmental factors (e.g., county case rates) than quality indicators. Whereas the roles of quality on the odds of having resident deaths, and the magnitude of resident cases and deaths, are more consistent in the later waves of the pandemic. Implications for future research and practice will be discussed.