COVID‐19 infections and deaths among Connecticut nursing home residents: facility correlates

Li, Yue; Temkin‐Greener, Helena; Gao, Shan; Cai, Xueya

OBJECTIVE: To determine the associations of nursing home registered nurse (RN) staffing, overall quality of care, and concentration of Medicaid or racial and ethnic minority residents with COVID‐19 confirmed cases and deaths by April 16, 2020 among Connecticut nursing home residents. DESIGN: Cross‐sectional analysis on Connecticut nursing home (n=215) COVID‐19 report, linked to other nursing home files and county counts of confirmed cases and deaths. Multivariable two‐part models determined the associations of key nursing home characteristics with the likelihood of at least 1 confirmed case (or death) in the facility, and with the count of cases (deaths) among facilities with at least 1 confirmed case (death). RESULTS: The average number of confirmed cases was 8 per nursing home (zero in 107 facilities), and the average number of confirmed deaths was 1.7 per nursing home (zero in 131 facilities). Among facilities with at least 1 confirmed case, every 20 minutes (per resident day) increase in RN staffing was associated with 22% fewer confirmed cases (incidence rate ratio [IRR]=0.78, 95% confidence interval [CI] 0.68‐0.89, p<0.001); compared to 1‐ to 3‐star facilities, 4‐ or 5‐star facilities had 13% fewer confirmed cases (IRR=0.87, 95% CI 0.78‐0.97, p<0.015); and facilities with high concentration of Medicaid residents (IRR=1.16, 95% CI 1.02‐1.32, p=0.025) or racial/ethnic minority residents (IRR=1.15, 95% CI 1.03‐1.29, p=0.026) had 16% and 15% more confirmed cases, respectively, than their counterparts. Among facilities with at least 1 death, every 20 minutes increase in RN staffing significantly predicted 26% fewer COVID‐19 deaths (IRR=0.74, 95% CI 0.55‐1.00, p=0.047). Other focused characteristics did not show statistically significant associations with deaths. CONCLUSIONS: Nursing homes with higher RN staffing and quality ratings have the potential to better control the spread of the novel coronavirus and reduce deaths. Nursing homes caring predominantly for Medicaid or racial and ethnic minority residents tend to have more confirmed cases.