COVID‐19 Pandemic in Assisted Living Communities: Results from Seven States

Temkin‐Greener, Helena; Guo, Wenhan; Mao, Yunjiao; Cai, Xueya; Li, Yue

OBJECTIVE: To describe variations in COVID‐19 confirmed cases and deaths among assisted living (AL) residents and examine their associations with key AL characteristics. DESIGN: Observational study employing data on confirmed COVID‐19 cases and deaths in ALs from seven states, through May 29, 2020. SETTING: Information on COVID‐19 cases/deaths in ALs was obtained from state government websites. A national inventory of ALs was used to identify communities with and without COVID‐19 cases/deaths. Medicare Beneficiary Summary File (MBSF) identifying AL residents was employed to develop AL characteristics. County‐level COVID‐19 lab‐confirmed cases/deaths were obtained from publicly available data. PARTICIPANTS: We found 4,865 ALs (2,647 COVID‐19 cases and 777 deaths) in the 7 states. After excluding missing data the sample consisted of 3,994 ALs (82.1%) with 2,542 cases (96.0%) and 675 deaths (86.9%). MAIN OUTCOMES AND MEASURES: Outcomes were AL‐level counts of cases and deaths. Covariates were AL characteristics and county‐level confirmed COVID‐19 cases/deaths. Multivariable 2‐part models determined the associations of independent variables with the likelihood of at least one case and death in the AL, and with the count of cases (deaths). RESULTS: State case fatality ranged from 3.32% in North Carolina to 9.26% in Connecticut, but for ALs in these states it was 12.89% and 31.59%, respectively. Among ALs with at least 1 case, mid‐size communities had fewer cases (IRR=0.829; p=0.004), than very small ALs. ALs with higher proportions of racial/ethnic minorities had more COVID‐19 cases (IRR=1.08; p<0.001), as did communities with higher proportions of residents with dementia, COPD and obesity. CONCLUSIONS AND RELEVANCE: ALs with a higher proportion of minorities had more COVID‐19 cases. Many of the previously identified individual risk factors are also present in this vulnerable population. The impact of COVID‐19 on ALs is as critical as that on nursing homes, and is worth equal attention from policy makers.