Nontraditional Small House Nursing Homes Have Fewer COVID-19 Cases and Deaths

Zimmerman, Sheryl; Dumond-Stryker, Carol; Tandan, Meera; Preisser, John S.; Wretman, Christopher J.; Howell, Abigail A.; Ryan, Susan

doi:10.1016/j.jamda.2021.01.069

Cited by 62 publications

(71 citation statements)

References 16 publications

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“…The number of beds was positively associated with higher COVID-19 cases, consistent with prior studies (in other States) (11,13,18). There have been some studies that have found that smaller NHs, especially greenhouse NHs fared better in the COVID-19 pandemic (13). The stated reasons were that smaller NHs' residents have better psychosocial well-being, such NHs are usually not-for-profit, and that the resident case mix usually have less minority population (that are often at higher mortality risk) (13).…”

Section: Discussionsupporting

confidence: 88%

“…However, Illinois was leading in the number of COVID-19 cases until October 2020 (11). The number of beds was positively associated with higher COVID-19 cases, consistent with prior studies (in other States) (11,13,18). There have been some studies that have found that smaller NHs, especially greenhouse NHs fared better in the COVID-19 pandemic (13).…”

Section: Discussionsupporting

confidence: 83%

“…Given that staff turnover rates are very high in nursing homes, training and maintaining sanitary protocols can also be challenging in this environment (4). Using datasets available from CMS, which consists of selfreported data from NHs around the country on various factors, many studies (10)(11)(12)(13)(14) have reported findings on the factors associated with nursing homes and COVID-19 cases for various time periods in 2020. There have also been several single-state studies e.g.…”

Section: Nursing Home Vulnerabilities Amid Covid-19 Pandemicmentioning

confidence: 99%

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Nursing Home Vulnerabilities amid COVID-19 Pandemic: A Study of Midwestern States

Nambisan¹,

Abahussain²,

Duthie³

et al. 2021

Jour Nursing Home Res

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Background: The COVID-19 pandemic disproportionately affected the older adult population, especially those in nursing homes (NHs). However, there is also evidence that some NHs fared better than others. Objectives: This study examines a set of nursing home related factors to understand whether these factors are associated with the number of COVID-19 cases. Design: We combined three datasets from the Centers for Medicare & Medicaid Services (CMS) – the Star Rating Dataset, the Provider Information Dataset, and the COVID-19 Nursing Home Dataset. Setting and Participants: 4390 NHs that responded to the CMS survey. Methods: Data used is from the period of Jan 1–Dec 27, 2020 for all 12 Midwestern states. The measures used were self-reported information on ratings, staff shortages, PPE shortage, number of beds, Registered Nurse (RN), Licensed Practical Nurses (LPN), Certified Nursing Assistants (CNA) hours per resident, star rating and ownership. Results: Of the 4390 NHs in 12 Midwestern states, high performing NHs were less likely to have more than 30 COVID-19 cases versus low-performing facilities for two of the CMS domains (health inspections, 520 NHs [27.6%] vs 1363 NHs [72.4%]; and staffing 773 NHs [41.1%] vs 1110 NHs [58.9%]). There was also a statistically significant association COVID-19 cases and star rating, NH ownership, NH size, RN, LPN, and CNA staffing in NHs (all p ≤ 0.01). NH ownership status persisted as a predictor of COVID 19 cases when controlled for NH size. Conclusions: Our study highlights two interesting findings. A) a statistically significant association between NH ownership structure and COVID-19 cases among residents - for-profit NHs had higher number of COVID-19 cases B) a statistically significant negative association between RN and CNA staffing and COVID-19 cases (i.e., more staffing hours of RNs and CNA correlated with a smaller number of COVID-19 cases) and a statistically significant positive association between LPN staffing and COVID-19 cases. We discuss ensuing policy implications for NHs.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 83%

Section: Nursing Home Vulnerabilities Amid Covid-19 Pandemicmentioning

confidence: 99%

See 1 more Smart Citation

Nursing Home Vulnerabilities amid COVID-19 Pandemic: A Study of Midwestern States

Nambisan¹,

Abahussain²,

Duthie³

et al. 2021

Jour Nursing Home Res

View full text Add to dashboard Cite

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“…10,12,14 In contrast, less crowded homes had fewer and smaller outbreaks. 15 For example, the Green House model is more residentcentered, with greater staff consistency, and houses 8 to 12 residents per lodging, each with their own bedroom and bathroom. 16 Data suggest that the Green House model leads to better resident outcomes and lower hospitalization costs, which may partially offset increased costs associated with the homes themselves.…”

mentioning

confidence: 99%

Proceedings from an International Virtual Townhall: Reflecting on the COVID-19 Pandemic: Themes from Long-Term Care

Heckman

Kay²,

Morrison³

et al. 2021

Journal of the American Medical Directors Association

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Residents of long-term care (LTC) homes have suffered disproportionately during the Covid-19 pandemic, from the virus itself and often from the imposition of lockdown measures. Provincial Geriatrics Leadership Ontario, in collaboration with interRAI and the International Federation on Aging, hosted a virtual Town Hall on September 25 2020. The purpose of this event was to bring together international perspectives from researchers, clinicians, and policy experts to address important themes potentially amenable to timely policy interventions. This manuscript summarizes these themes and the ensuing discussions among 130 attendees from 5 continents. The disproportionate impact of the Covid-19 pandemic on frail residents of LTC homes reflects a systematic lack of equitable prioritization by health system decision-makers around the world. The primary risk factors for an outbreak in a LTC home were outbreaks in the surrounding community, high staff and visitor traffic in large facilities, and crowding of residents in ageing buildings. Infection control measures must be prioritized in LTC homes, though care must be taken to protect frail and vulnerable residents from their overly blunt application that deprives residents from appropriate physical and psychosocial support. Staffing, in terms of overall numbers, training, and leadership skills, was inadequate. The built environment of LTC homes can be configured for both optimal resident well-being and infection control. Infection control and resident wellness need not be mutually exclusive. Improving outcomes for LTC residents requires more staffing with proper training and interprofessional leadership. All these initiatives must be underpinned by an effective quality assurance system based on standardized, comprehensive, accessible, and clinically relevant data, and which can support broad communities of practice capable of effecting real and meaningful change for frail older persons, wherever they chose to reside.

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“…These results differ from those of other studies that identified structural and organizational factors related to an increased risk of COVID-19 infection among residents. Some of these factors, including location, larger facility size, nursing staff levels under the recommended standard, for-profit status, low overall quality rating, and movement of staff between facilities have been confirmed as detrimental in various publications [36][37][38][39][40][41][42][43][44][45].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors Associated with Nursing Home COVID-19 Outbreaks: A Retrospective Cohort Study

Cazzoletti

Zanolin

Tussardi

et al. 2021

IJERPH

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Background: The coronavirus disease 2019 (COVID-19) pandemic had a devastating impact on nursing homes/long-term care facilities. This study examined the relationship between geography, size, design, organizational characteristics, and implementation of infection prevention and control (IPC) measures and the extent of COVID-19 outbreaks in nursing homes in the Autonomous Province of Trento (Italy) during the time frame of March-May 2020. Methods: The analysis included 57 nursing homes (5145 beds). The association between median cumulative incidence of COVID-19 cases among residents and characteristics of nursing homes was assessed by Mann–Whitney U test, Kruskal–Wallis test or Spearman rho. To evaluate the potential confounding of geographical area, a 2-level random intercept logistic model was fitted, with level 1 units (patients in nursing homes) nested into level 2 units (nursing homes), and “being a COVID-19 case” as the dependent variable. Results: Median cumulative incidence was not significantly associated with any of the variables, except for geographical region (p = 0.002). COVID-19 cases clustered in the part of the province bordering the Italian region most affected by the pandemic (Lombardy) (45% median cumulative incidence). Conclusions: Structural/organizational factors and standard IPC measures may not predict the epidemiology of COVID-19 outbreaks and be sufficient alone to protect nursing homes against them.

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Nontraditional Small House Nursing Homes Have Fewer COVID-19 Cases and Deaths

Cited by 62 publications

References 16 publications

Nursing Home Vulnerabilities amid COVID-19 Pandemic: A Study of Midwestern States

Nursing Home Vulnerabilities amid COVID-19 Pandemic: A Study of Midwestern States

Proceedings from an International Virtual Townhall: Reflecting on the COVID-19 Pandemic: Themes from Long-Term Care

Risk Factors Associated with Nursing Home COVID-19 Outbreaks: A Retrospective Cohort Study

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