Objective To describe variations in COVID‐19 confirmed cases and deaths among assisted living (AL) residents and examine their associations with key AL characteristics. Design Observational study employing data on confirmed COVID‐19 cases and deaths in ALs from seven states, through May 29, 2020. Setting Information on COVID‐19 cases/deaths in ALs was obtained from state government websites. A national inventory of ALs was used to identify communities with and without COVID‐19 cases/deaths. Medicare Beneficiary Summary File (MBSF) identifying AL residents was employed to develop AL characteristics. County‐level COVID‐19 lab‐confirmed cases/deaths were obtained from publicly available data. Participants We found 4,865 ALs (2,647 COVID‐19 cases and 777 deaths) in the 7 states. After excluding missing data the sample consisted of 3,994 ALs (82.1%) with 2,542 cases (96.0%) and 675 deaths (86.9%). Main Outcomes and Measures Outcomes were AL‐level counts of cases and deaths. Covariates were AL characteristics and county‐level confirmed COVID‐19 cases/deaths. Multivariable 2‐part models determined the associations of independent variables with the likelihood of at least one case and death in the AL, and with the count of cases (deaths). Results State case fatality ranged from 3.32% in North Carolina to 9.26% in Connecticut, but for ALs in these states it was 12.89% and 31.59%, respectively. Among ALs with at least 1 case, mid‐size communities had fewer cases (IRR=0.829; p=0.004), than very small ALs. ALs with higher proportions of racial/ethnic minorities had more COVID‐19 cases (IRR=1.08; p<0.001), as did communities with higher proportions of residents with dementia, COPD and obesity. Conclusions and Relevance ALs with a higher proportion of minorities had more COVID‐19 cases. Many of the previously identified individual risk factors are also present in this vulnerable population. The impact of COVID‐19 on ALs is as critical as that on nursing homes, and is worth equal attention from policy makers.

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BACKGROUND: Residents of long-term care facilities face significantly greater risk of contracting or dying from COVID-19. However, little is known about COVID-19 in assisted living communities (ALCs) and the potential determinants of its spread. We examined the association between COVID-19 cases in ALCs and the proportion of Medicare-Medicaid (dual) eligible minority residents, neighborhood area deprivation, and state COVID-19 policy stringency. METHODS: We conducted longitudinal analyses employing data on confirmed COVID-19 cases in ALCs within 5 states. Outcome was weekly cumulative number of COVID-19 cases in ALCs. Covariates were ALC characteristics, area deprivation index, and state COVID-19 policy stringency. Multivariate two-part models were used to determine the associations between independent variables and the likelihood of an outbreak and the overall count of cases. RESULTS: In our study sample, 201 ALCs (7.04%) reported 1 or more COVID-19 cases as of August 17th, 2020. A higher percentage of minority residents was associated with an increased likelihood of ALC reporting at least one COVID-19 case (OR=1.06, P=0.032). Conditional on having at least one case, ALCs in states with stricter social distancing policies had lower case count (IRR=0.98, P<0.001). Greater neighborhood deprivation was associated with higher case count (IRR=1.36, P=0.049). CONCLUSION: ALCs with higher proportions of dual-eligible minority residents were more likely to have COVID-19 outbreaks within their communities. ALCs located in more socioeconomically deprived neighborhoods, and in states with less stringent state social distancing policies tended to have more COVID-19 cases.

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