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Comparative Study
. 2020 Sep;68(9):1899-1906.
doi: 10.1111/jgs.16689. Epub 2020 Jul 21.

COVID-19 Infections and Deaths among Connecticut Nursing Home Residents: Facility Correlates

Yue Li  1 , Helena Temkin-Greener  1 , Gao Shan  2 , Xueya Cai  2
Affiliations
Comparative Study

COVID-19 Infections and Deaths among Connecticut Nursing Home Residents: Facility Correlates

Yue Li et al. J Am Geriatr Soc. 2020 Sep.

Abstract

Background/objectives: 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 2019 coronavirus disease (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 one confirmed case (or death) in the facility, and with the count of cases (deaths) among facilities with at least one confirmed case (death).

Setting: All Connecticut nursing homes (n = 215).

Participants: None.

Intervention: None.

Measurements: Numbers of COVID-19 confirmed cases and deaths among residents.

Results: The average number of confirmed cases was eight 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 one confirmed case, every 20-minute increase in RN staffing (per resident day) was associated with 22% fewer confirmed cases (incidence rate ratio [IRR] = .78; 95% confidence interval [CI] = .68-.89; P < .001); compared with one- to three-star facilities, four- or five-star facilities had 13% fewer confirmed cases (IRR = .87; 95% CI = .78-.97; P < .015), and facilities with high concentration of Medicaid residents (IRR = 1.16; 95% CI = 1.02-1.32; P = .025) or racial/ethnic minority residents (IRR = 1.15; 95% CI = 1.03-1.29; P = .026) had 16% and 15% more confirmed cases, respectively, than their counterparts. Among facilities with at least one death, every 20-minute increase in RN staffing significantly predicted 26% fewer COVID-19 deaths (IRR = .74; 95% CI = I .55-1.00; P = .047). Other focused characteristics did not show statistically significant associations with deaths.

Conclusion: 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.

Keywords: COVID-19; coronavirus; death; disparities; nursing home.

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Conflict of interest statement

The authors have declared no conflicts of interest for this article.

Figures

Figure 1
Figure 1
Predicted numbers of COVID‐19 (A) confirmed cases and (B) deaths among Connecticut nursing home residents (as of April 16, 2020) versus registered nurse (RN) staffing hours (P values are for the independent associations of RN staffing with predicted counts that were derived from the joint tests of the two‐part regression models).
See this image and copyright information in PMC

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