Characteristics of Nursing Homes by COVID-19 Cases among Staff: March to August 2020

Ryskina, Kira L.; Yun, Hyunkyung; Wang, Hannah; Chen, Angela T.; Jung, Hye-Young

Objective To measure the association between nursing home (NH) characteristics and COVID-19 prevalence among NH staff. Design Retrospective cross-sectional study. Setting and Participants: Centers for Disease Control COVID-19 database for US NHs between March and August 2020, linked to NH facility characteristics (LTCFocus database) and local COVID-19 prevalence (USA Facts). Methods We estimated the associations between NH characteristics, local infection rates, and other regional characteristics and COVID-19 cases among NH staff (nursing staff, clinical staff, aides, and other facility personnel) measured per 100 beds, controlling for the hospital referral regions in which NHs were located to account for local infection control practices and other unobserved characteristics. Results Of the 11,858 NHs in our sample, 78.6% reported at least one staff case of COVID-19. After accounting for local COVID-19 prevalence, NHs in the highest quartile of confirmed resident cases (413.5 to 920.0 cases per 1,000 residents) reported 18.9 more staff cases per 100 beds compared to NHs that had no resident cases. Large NHs (150 or more beds) reported 2.6 fewer staff cases per 100 beds compared to small NHs (<50 beds) and for-profit NHs reported 0.8 fewer staff cases per 100 beds compared to non-profit NHs. Higher occupancy and more direct care hours per day were associated with more staff cases (0.4 more cases per 100 beds for a 10% increase in occupancy, and 0.7 more cases per 100 beds for an increase in direct care staffing of 1 hour per resident day, respectively). Estimates associated with resident demographics, payer mix or regional socioeconomic characteristics were not statistically significant. Conclusions and implications These findings highlight the urgent need to support facilities with emergency resources such as back-up staff and protocols to reduce resident density within the facility which may help stem outbreaks.