Nursing home infection control strategies during the COVID-19 pandemic

Abstract

Background: The American Rescue Plan Act of 2021 awarded $500 million toward scaling "strike teams" to mitigate the impact of Coronavirus Disease 2019 (COVID-19) within nursing homes. The Massachusetts Nursing Facility Accountability and Support Package (NFASP) piloted one such model during the first weeks of the pandemic, providing nursing homes financial, administrative, and educational support. For a subset of nursing homes deemed high-risk, the state offered supplemental, in-person technical infection control support.

Methods: Using state death certificate data and federal nursing home occupancy data, we examined longitudinal all-cause mortality per 100,000 residents and changes in occupancy across NFASP participants and subgroups that varied in their receipt of the supplemental intervention.

Results: Nursing home mortality peaked in the weeks preceding the NFASP, with a steeper increase among those receiving the supplemental intervention. There were contemporaneous declines in weekly occupancy. The potential for temporal confounding and differential selection across NFASP subgroups precluded estimation of causal effects of the intervention on mortality.

Conclusions: We offer policy and design suggestions for future strike team iterations that could inform the allocation of state and federal funding. We recommend expanded data collection infrastructure and, ideally, randomized assignment to intervention subgroups to support causal inference as strike team models are scaled under the direction of state and federal agencies.

Keywords: American Rescue Plan Act of 2021; COVID-19; nursing homes; older adults; strike teams.

Figure 1. Trends in All-Cause Mortality within Nursing Facility Accountability and Support Package Subgroups

Notes: The exhibit displays all-cause mortality per 100,000 nursing home residents within the Base Intervention (SI) and Supplemental Intervention (SI) groups of the Nursing Home Facility Accountability and Support Package (NFASP). The trend in all-cause mortality per 100,000 Massachusetts residents not residing within nursing homes is provided as a reference. T1 spans the period preceding the first presumptive case of COVID-19 in Massachusetts (October 1, 2018-February 28^th, 2020). T2 spans the intervening weeks until the announcement of the NFASP (Feb 29th-April 27^th). T3 spans the 9-week NFASP intervention (April 28th-July 8^th). T4 spans the weeks following the NFASP until the announcement of the announcement of a renewed statewide intervention, “NFASP 2.0” within Massachusetts nursing homes (July 9th-Sept 10th, 2020).

Figure 2. Trends in Nursing Home Occupancy within Nursing Facility Accountability and Support Package Subgroups

Notes: The exhibit displays the percentage of certified beds occupied within the Base Intervention (SI) and Supplemental Intervention (SI) groups of the Nursing Home Facility Accountability and Support Package (NFASP). T1 spans the period preceding the first presumptive case of COVID-19 in Massachusetts (October 1, 2018-February 28^th, 2020). T2 spans the intervening weeks until the announcement of the NFASP (Feb 29th-April 27^th). T3 spans the 9-week NFASP intervention (April 28th-July 8^th). T4 spans the weeks following the NFASP until the announcement of the announcement of a renewed statewide intervention, “NFASP 2.0” within Massachusetts nursing homes (July 9th-Sept 10th, 2020).