COVID-19 Cases and Deaths in Skilled Nursing Facilities in Cook County, Illinois

Abstract

Objective: The COVID-19 pandemic has had a devastating impact on older adults residing in skilled nursing facilities. This study examined the pathways through which community and facility factors may have affected COVID-19 cases and deaths in skilled nursing facilities. Methods: We used structural equation modeling to examine the number of COVID-19 cases and deaths in skilled nursing facilities in Cook County, Illinois, from January 1 through September 30, 2020. We used data from the Centers for Medicare & Medicaid Services, the Illinois Department of Public Health, and the Cook County Medical Examiner’s Office to determine the number of resident COVID-19 cases and deaths, number of staff cases, facility-level characteristics, and community-level factors. Results: Poorer facility quality ratings and higher numbers of staff COVID-19 cases were associated with increased numbers of resident COVID-19 cases and deaths. For-profit ownership was associated with larger facilities and higher resident-to-staff ratios, which increased the number of staff COVID-19 cases. Furthermore, skilled nursing facilities with a greater percentage of White residents were in areas with lower levels of social vulnerability and were less likely to be for-profit and, thus, were associated with higher quality. Conclusions: For-profit ownership was associated with lower facility quality ratings and increases in the number of staff COVID-19 cases, leading to increased resident COVID-19 cases and deaths. Establishing enforceable regulations to ensure quality standards in for-profit skilled nursing facilities is critical to prevent future outbreaks and reduce health disparities in facilities serving racial and ethnic minority populations.

Drivers of COVID-19 Outcomes in Long-Term Care Facilities Using Multi-Level Analysis: A Systematic Review

“…The organizational factors that consistently emerged and were supported by a substantial body of evidence with relation to mortality include LTCF's racial and ethnic composition [2,63,67,70,75,81,83,85,89,95,96,103,109,110], for-profit and/or private ownership [2,24,30,56,63,83,87,98,102,104,113], nursing staffing levels [2,48,56,75,80,81,92,94,98,110], star rating and subdomains (inverse association) [63,74,81,87,88,98,111,113], infected staff [27,56,66,89,113], chain membership…”

“…The organizational factors that consistently emerged and were supported by a substantial body of evidence with relation to outbreak include staffing levels [26,28,34,48,56,59,70,72,76,79,80,82,84,91,92,94,97,99,106,113], star/subset domains ratings [59,63,69,71,74,76,79,82,83,88,89,94,99,106,111,113], LTCFs with a higher proportion of racial and ethnic minorities [67,70,73,77,81,83,84,89,94,95,99,101,105,…”

Resident racial and ethnic composition, neighborhood‐level socioeconomic status, and COVID‐19 infections in California SNFs

“…11 As a result of limited access to resources, SNFs that are located in communities of color are less likely to have protective measures such as personal protective equipment (PPE) and are of lower quality compared to SNFs located in predominantly White neighborhoods. 12 , 13 …”

“…For instance, neighborhood segregation was found to be associated with SNF resident segregation, 8 and, past work has shown SNFs are less likely to be located in communities of color 11 . As a result of limited access to resources, SNFs that are located in communities of color are less likely to have protective measures such as personal protective equipment (PPE) and are of lower quality compared to SNFs located in predominantly White neighborhoods 12,13 …”

“…11 As a result of limited access to resources, SNFs that are located in communities of color are less likely to have protective measures such as personal protective equipment (PPE) and are of lower quality compared to SNFs located in predominantly White neighborhoods. 12,13 Unequal access to resources, racial and ethnic composition of residents, and neighborhood-level factors may therefore be associated with higher COVID-19 incidence in SNFs. 14,15 Recent research found SNFs with higher staffing and quality ratings had a lower number of confirmed COVD-19 infections and deaths, and SNFs that predominantly served racially and ethnically minoritized residents had more COVID-19 infections.…”