COVID‐19 Infections and Deaths among Connecticut Nursing Home Residents: Facility Correlates

Abstract

BACKGROUND/OBJECTIVES To determine the associations of nursing home registered nurse (RN) staffing, overall quality of care, and concentration of Medicaid or racial and ethnic minority residents with 2019 coronavirus disease (COVID‐19) confirmed cases and deaths by April 16, 2020, among Connecticut nursing home residents. DESIGN Cross‐sectional analysis on Connecticut nursing home (n = 215) COVID‐19 report, linked to other nursing home files and county counts of confirmed cases and deaths. Multivariable two‐part models determined the associations of key nursing home characteristics with the likelihood of at least one confirmed case (or death) in the facility, and with the count of cases (deaths) among facilities with at least one confirmed case (death). SETTING All Connecticut nursing homes (n = 215). PARTICIPANTS None. INTERVENTION None. MEASUREMENTS Numbers of COVID‐19 confirmed cases and deaths among residents. RESULTS The average number of confirmed cases was eight per nursing home (zero in 107 facilities), and the average number of confirmed deaths was 1.7 per nursing home (zero in 131 facilities). Among facilities with at least one confirmed case, every 20‐minute increase in RN staffing (per resident day) was associated with 22% fewer confirmed cases (incidence rate ratio [IRR] = .78; 95% confidence interval [CI] = .68–.89; P < .001); compared with one‐ to three‐star facilities, four‐ or five‐star facilities had 13% fewer confirmed cases (IRR = .87; 95% CI = .78–.97; P < .015), and facilities with high concentration of Medicaid residents (IRR = 1.16; 95% CI = 1.02–1.32; P = .025) or racial/ethnic minority residents (IRR = 1.15; 95% CI = 1.03–1.29; P = .026) had 16% and 15% more confirmed cases, respectively, than their counterparts. Among facilities with at least one death, every 20‐minute increase in RN staffing significantly predicted 26% fewer COVID‐19 deaths (IRR = .74; 95% CI = I .55–1.00; P = .047). Other focused characteristics did not show statistically significant associations with deaths. CONCLUSION Nursing homes with higher RN staffing and quality ratings have the potential to better control the spread of the novel coronavirus and reduce deaths. Nursing homes caring predominantly for Medicaid or racial and ethnic minority residents tend to have more confirmed cases.

August 2020 Interim EuGMS guidance to prepare European Long-Term Care Facilities for COVID-19

“…In a recent study, every 20 min (per resident day) increase in registered nurse staffing was associated with a 22% reduction in the number of confirmed COVID-19 cases (in facilities with at least one confirmed case) and with 26% fewer COVID-19 deaths (in facilities with at least one death due to this infection). This confirms the importance of the qualified staff in preventing SARS-CoV-2 dissemination in LTCFs [ 53 ].…”

Comparative Performance of Private Equity–Owned US Nursing Homes During the COVID-19 Pandemic

“…Although no previous research that we are aware of has examined PE ownership and outcomes associated with COVID-19, 6 recent studies 4 , 26 , 27 , 28 , 29 , 30 compared outcomes of for-profit nursing homes with nursing homes with other types of ownership. The findings of these studies were inconsistent.…”

COVID‐19 in Nursing Homes: Calming the Perfect Storm

“…In addition, nursing homes should have reasonable protection from legal liability for simply having COVID-19 cases and mortality, as it is clear that even high-quality nursing homes with sound infection control practices can have these occurrences. [3][4][5]20 • Where accurate tests are available, universal viral testing can be helpful in establishing a baseline of how many residents and staff have the virus, and for developing a staffing and isolation/quarantine plan…”

“…In a study published in JAGS involving Connecticut nursing homes, the acquisition of the virus was not associated with quality ratings. 20 However, among facilities with at least one case, the average number of cases was lower in facilities with higher quality ratings and higher nursing staffing. This study suggests that better quality facilities with higher levels of nursing staffing are better prepared to contain the spread of the virus once it is in the facility.…”