Is There a Link between Nursing Home Reported Quality and COVID-19 Cases? Evidence from California Skilled Nursing Facilities

Abstract

Objectives: During the Coronavirus disease 2019 (COVID-19) outbreak in the United States, nursing homes became the hotbed for the spread of COVID-19. States developed different policies to mitigate the COVID-19 risks at nursing homes, including limiting nursing home visitation and mandating staff screening. The purpose of this study is to examine whether COVID-19 cases and deaths are related to the nursing home reported quality. Design: We combined the COVID-19 data reported by the California Department of Public Health, quality ratings provided by Nursing Home Compare, and patient racial information from Long-Term Care Focus to examine the association between nursing home reported quality and COVID-19 cases and deaths. Settings and Participants: Cross-sectional data from 1223 California skilled nursing facilities with reported quality and longitudinal data of COVID-19 cases were used. Methods: The dependent variable is COVID-19 residents' cases and deaths. The main independent variable is nursing home reported quality. Nursing home ownership, size, years of operation, and patient race composition are also included. Results: Nursing home star ratings and greater percentage of residents from different racial and ethnicity groups were significantly (P < .01) related to increased probability of having a COVID-19 residents' case or death. Conclusions and Implications: Nursing homes with 5-star ratings were less likely to have COVID-19 cases and deaths after adjusting for nursing home size and patient race proportion.

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.…”

Racial and Ethnic Disparities in COVID‐19 Infections and Deaths Across U.S. Nursing Homes

“…Thus, similar to previous studies, [14][15][16] we categorized nursing homes into quartiles to capture such nonlinear associations: nursing homes with low proportions of racial/ethnic minority residents (<2.92%, the 25th percentile), medium proportions (2.92%-11.11%, the median), medium-high proportions (11.11%-30.18%), and high proportions (≥30.18%, the 75th percentile). From the NHC files, we obtained a set of nursing home covariates that were found important to COVID-19 infections or deaths, [16][17][18][19] including number of beds, average daily resident census, ownership status (for profit, nonprofit, or government owned), chain affiliation (yes/no), whether the nursing home is affiliated with a hospital, percentage of Medicare residents, percentage of Medicaid residents, average staffing levels (hours per resident day) for RN and for all nursing staff (including RNs, LPNs/LVNs, and certified nursing assistants) in 2019, and five-star ratings for overall quality of care. RN and other nurse staffing levels were calculated based on daily resident census and CMS Payroll-Based Journal system through which nursing homes electronically submit the number of hours that agency and contract staff are paid to work each day; the payroll-based data are submitted quarterly and audited by CMS to ensure accuracy.…”

Nursing Home Staff Networks and COVID-19

“…No study finds CMS ratings to be significant explanators of cases, although demographics and urban location are predictive of cases. Two studies of individual states (He et al, 2020; find that higher CMS-rated nursing homes report fewer cases. One analysis finds no evidence that for-profit status significantly predicts nursing home cases (Konetzka, 2020), yet a study of Connecticut facilities does find for-profit status to be a predictor of cases (Rowan et al, 2020).…”