The association of nursing home quality ratings and spread of COVID‐19

Williams, Christianna S.; Zheng, Qing; White, Alan J.; Bengtsson, Ariana I.; Shulman, Evan T.; Herzer, Kurt R.; Fleisher, Lee A.

OBJECTIVES: The coronavirus disease 2019 (COVID‐19) pandemic has severely affected nursing home residents. Given the continued high incidence of COVID‐19, and the likelihood that new variants and other infectious agents may cause future outbreaks, we sought to understand the relationship of nursing home quality ratings and measures of COVID‐19 outbreak severity and persistence. DESIGN: We analyzed nursing home facility‐level data on COVID‐19 cases and deaths, county‐level COVID‐19 rates, and nursing home data from the Centers for Medicare & Medicaid Services (CMS), including ratings from the CMS Nursing Home Five‐Star Quality Rating System. We used regression analysis to examine the association between star ratings and cumulative COVID‐19 incidence and mortality as well as persistent high resident incidence. SETTING: All nursing homes in the CMS COVID‐19 Nursing Home Dataset reporting data that passed quality assurance checks for at least 20 weeks and that were included in the January 2021 Nursing Home Care Compare update. PARTICIPANTS: Residents of the included nursing homes. MEASUREMENTS: Cumulative resident COVID‐19 incidence and mortality through January 10, 2021; number of weeks with weekly resident incidence of COVID‐19 in the top decile nationally. RESULTS: As of January 10, 2021, nearly all nursing homes (93.6%) had reported at least one case of COVID‐19 among their residents, more than three‐quarters (76.9%) had reported at least one resident death, and most (83.5%) had experienced at least 1 week in the top decile of weekly incidence. In analyses adjusted for facility and county‐level characteristics, we found generally consistent relationships between higher nursing home quality ratings and lower COVID‐19 incidence and mortality, as well as with fewer high‐incidence weeks. CONCLUSION: Nursing home quality ratings are associated with COVID‐19 incidence, mortality, and persistence. Nursing homes receiving five‐star ratings, for overall quality as well as for each domain, had lower COVID‐19 rates among their residents.