The Adverse Effects of the COVID-19 Pandemic on Nursing Home Resident Well-Being

Abstract

Objective: Quantify the effects of the COVID-19 pandemic on nursing home resident well-being.

Design: Quantitative analysis of resident-level assessment data.

Setting and participants: Long-stay residents living in Connecticut nursing homes.

Methods: We used Minimum Data Set assessments to measure nursing home resident outcomes observed in each week between March and July 2020 for long-stay residents (eg, those in the nursing home for at least 100 days) who lived in a nursing home at the beginning of the pandemic. We compared outcomes to those observed at the beginning of the pandemic, controlling for both resident characteristics and patterns for outcomes observed in 2017-2019.

Results: We found that nursing home resident outcomes worsened on a broad array of measures. The prevalence of depressive symptoms increased by 6 percentage points relative to before the pandemic in the beginning of March-representing a 15% increase. The share of residents with unplanned substantial weight loss also increased by 6 percentage points relative to the beginning of March-representing a 150% increase. We also found significant increases in episodes of incontinence (4 percentage points) and significant reductions in cognitive functioning. Our findings suggest that loneliness and isolation play an important role. Though unplanned substantial weight loss was greatest for those who contracted COVID-19 (about 10% of residents observed in each week), residents who did not contract COVID-19 also physically deteriorated (about 7.5% of residents in each week).

Conclusions and implications: These analyses show that the pandemic had substantial impacts on nursing home residents beyond what can be quantified by cases and deaths, adversely affecting the physical and emotional well-being of residents. Future policy changes to limit the spread of COVID-19 or other infectious disease outbreaks should consider any additional costs beyond the direct effects of morbidity and mortality due to COVID-19.

Keywords: COVID-19; nursing home residents; pandemic; well-being.

Fig. 1

Graph demonstrating the attrition of long-stay residents between March 9 and August 31 of 2020, 2019, 2018, and 2017. The January–March 9 time period was used to define our long-stay study sample for each year.

Fig. 2

The figure uses an event study framework to estimate the impact of the pandemic on outcomes. Each point represents the impact of the pandemic in that week, relative to an impact of zero in the week of March 10, 2020, which represents the onset of the pandemic. Mechanically, this means that each point shows the difference in average outcomes for residents with regular MDS assessments that week in 2020 relative to outcomes observed in the same week averaged across 2017–2019, relative to a difference of zero in the week of March 10. For each of the 4 years included in the regression, the sample includes long-stay residents of the nursing home present as of March 9 of that year who had a regular assessment during the given time period. The points in January and February show pre-trends for the same sample of people. The model also reweights the sample in each week to ensure observable characteristics are equal in all time periods, and controls directly for these characteristics. Bars represent the 95% confidence interval accounting for standard errors clustered at the nursing home level, so that statistical significance is indicated if the bars are wholly above or below the zero line. The Cognitive Function Scale ranges from 0 to 6, with a higher score indicating a more severe impairment. The Activities of Daily Living scale ranges from 0 to 16, with a higher score indicating that the resident requires more functional assistance or support.

Fig. 3

The figure plots average outcomes observed in each week, reporting separately by whether or not the resident ever tested positive for COVID-19. It only includes long-stay residents of the nursing home who were present in the facility as of March 9, 2020. The Cognitive Function Scale ranges from 0 to 6, with a higher score indicating a more severe impairment. The Activities of Daily Living Scale ranges from 0 to 16, with a higher score indicating that the resident requires more functional assistance or support.

Supplementary Fig. 1

The figure uses the same event study framework as the primary impact model but shows whether the characteristics of residents who are observed in each week differ over time. Each point represents the impact of the pandemic on the sample in that week, relative to those observed in the week of March 10, 2020, which represents the onset of the pandemic. Mechanically, this means that each point shows the difference in average characteristics for residents with regular MDS assessments that week in 2020 relative to characteristics observed in the same week averaged across 2017–2019, relative to a difference of zero in the week of March 10. For each of the 4 years included in the regression, the sample includes people who lived in the nursing home on March 9 of that year and includes all subsequent observations through July 31. The points in January and February show pre-trends for the same sample of people. The model does not reweight or control for any characteristics, unlike the primary impact model. Bars represent the 95% confidence interval accounting for standard errors clustered at the nursing home level, so that statistical significance at the 95% level is indicated if the bars are wholly above or below the zero line.

Supplementary Fig. 2

The figure shows average outcomes for residents with regular MDS assessments over time (grouped by week). It includes long-stay residents who were present as of March 9 of the given year and had a regular assessment during the given time period. The Cognitive Function Scale ranges from 0 to 6, with a higher score indicating a more severe impairment. The Activities of Daily Living Scale ranges from 0 to 16, with a higher score indicating that the resident requires more functional assistance or support.