A systematic review of long‐term care facility characteristics associated with COVID‐19 outcomes

Abstract

Background/Objectives: The coronavirus disease 2019 (COVID-19) pandemic has taken a disproportionate toll on long-term care facility residents and staff. Our objective was to review the empirical evidence on facility characteristics associated with COVID-19 cases and deaths.Design: Systematic review. Setting: Long-term care facilities (nursing homes and assisted living communities).Participants: Thirty-six empirical studies of factors associated with COVID-19 cases and deaths in long-term care facilities published between January 1, 2020 and June 15, 2021. Measurements: Outcomes included the probability of at least one case or death (or other defined threshold); numbers of cases and deaths, measured variably. Results: Larger, more rigorous studies were fairly consistent in their assessment of risk factors for COVID-19 outcomes in long-term care facilities. Larger bed size and location in an area with high COVID-19 prevalence were the strongest and most consistent predictors of facilities having more COVID-19 cases and deaths. Outcomes varied by facility racial composition, differences that were partially explained by facility size and community COVID-19 prevalence. More staff members were associated with a higher probability of any outbreak; however, in facilities with known cases, higher staffing was associated with fewer deaths. Other characteristics, such as Nursing Home Compare 5-star ratings, ownership, and prior infection control citations, did not have consistent associations with COVID-19 outcomes. Conclusion: Given the importance of community COVID-19 prevalence and facility size, studies that failed to control for these factors were likely confounded. Better control of community COVID-19 spread would have been critical for mitigating much of the morbidity and mortality long-term care residents and staff experienced during the pandemic. Traditional quality measures such as Nursing Home Compare 5-Star ratings and past deficiencies were not consistent indicators of pandemic preparedness, likely because COVID-19[Correction added after first online publication on September 24, 2021. Keypoints have been changed.]

COVID-19 pandemic and mortality in nursing homes across USA and Europe up to October 2021

“…Our study findings are in line with previous data suggesting that the prevalence of COVID-19 in the community is a strong predictor of COVID-19 spread in NHs [ 3 , 4 , 9 ]. In addition, larger NH facilities have been associated with a greater likelihood of COVID-19 outbreaks than smaller units [ 5 , 9 ].…”

“…Our study findings are in line with previous data suggesting that the prevalence of COVID-19 in the community is a strong predictor of COVID-19 spread in NHs [ 3 , 4 , 9 ]. In addition, larger NH facilities have been associated with a greater likelihood of COVID-19 outbreaks than smaller units [ 5 , 9 ]. It has become evident that the structure in many NHs is suboptimal, as several residents often share a room facilitating the spread of health care-associated infections and hampering the isolation and quarantine measures [ 10 ].…”

“…As limitations, we do not have data on facility level resident characteristics, staffing resources or qualifications, vaccinations, resident density, or their transit to/from hospitals. These have been associated with COVID-19 infection rate and mortality [ 3 , 5 , 9 , 11 – 13 ]. It is well known that the education and qualification of staffing varies greatly between the countries.…”

Quality of Life, Insomnia and Coping Strategies during COVID-19 Pandemic in Hospital Workers. A Cross-Sectional Study

“…Coronavirus disease (COVID- 19), which started in Wuhan, China, in December 2019, became a pandemic in a few months, leading to extraordinary risks to human beings [1]. Despite the majority of infected subjects having a moderate illness and about 10-15% of patients developing grave complications [2], until 21 October 2021, about 4.9 million deaths were declared, with over 241 million cases confirmed globally [3].…”

COVID-19’s Influence on Information and Communication Technologies in Long-Term Care: Results From a Web-Based Survey With Long-Term Care Administrators

“…Most studies examining how the COVID-19 pandemic has affected the lives of older adults have concentrated on community-dwelling adults. Among the COVID-19-related studies on LTC [25], the main focus has been on the medical circumstances (eg, cases, outbreaks, and personal protective equipment) pertaining COVID-19 [2,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41], LTC employees [2,[42][43][44][45][46][47], communication with family members [36,48], or provision of training on LTC issues related to the COVID-19 pandemic [24,49,50].…”