key: cord-321606-o0gfukzg
authors: Unruh, Mark Aaron; Yun, Hyunkyung; Zhang, Yongkang; Braun, Robert T.; Jung, Hye-Young
title: Nursing Home Characteristics Associated with COVID-19 Deaths in Connecticut, New Jersey, and New York
date: 2020-06-15
journal: J Am Med Dir Assoc
DOI: 10.1016/j.jamda.2020.06.019
sha: 
doc_id: 321606
cord_uid: o0gfukzg

nan

Nursing home patients have been disproportionately affected by COVID-19. It has been 4 reported that one-fourth of all COVID-19 deaths nationwide occurred in nursing homes and 5 other long-term care facilities. 1 The objective of this study was to compare the characteristics 6 of nursing homes with COVID-19 deaths to other nursing homes using data from Connecticut, 7 New Jersey, and New York. 8 We merged data on nursing home characteristics from the 2017 LTCFocus database 9 (Long Term Care: Facts on Care in the US) with data on nursing homes with COVID-19 deaths 10 provided by the states of Connecticut , New Jersey, and New York. Data from Connecticut 11 included deaths as of April 16th, New Jersey as of April 20th, and New York as of April 15th. 12

After excluding 28 facilities with incomplete information, our sample included 1,162 nursing 13 homes. 14 Data from Connecticut and New Jersey identified nursing homes with 1 or more COVID-15 19 deaths, but data for New York only identified nursing homes with 6 or more COVID-19 16 deaths. Therefore, we created a binary outcome of whether a nursing home had 6 or more 17 COVID-19 deaths. Nursing home characteristics included mean age of residents, percent 18 female, percent white, mean Resource Utilization Group case-mix index, mean activities of daily 19 living (ADL) score, percent restrained, total number of beds, occupancy rate, for-profit status, 20 multi-facility chain membership, mean direct care hours per patient day, presence of an the distributions of the percent of patients covered by Medicaid patients and the percent 23 covered by Medicare were also included. 24

Predicted probabilities were estimated with logistic regression using the covariates 25 listed above in addition to indicators for states. Secondary analyses were conducted (1) with 26 samples for each of the three states and (2) by repeating our primary analysis with the sample 27 limited to nursing homes with 100 or more beds. Although an outcome measure reflecting the 28 number of COVID-19 deaths per nursing home bed would have been ideal, the data did not 29 permit this. Nevertheless, our regression estimates reflect the probability of a nursing home 30 having 6 or more COVID-19 deaths, holding the number of beds in the facility constant. 31

Among the 1,162 nursing homes in our sample, 184 (15.8%) had 6 or more COVID-19 32 deaths. 33

Estimates from our primary analysis (Table) estimates for these measures were not statistically significant for nursing homes in Connecticut 45 or New Jersey. The results of our secondary analysis of nursing homes with 100 or more beds 46 (Table) were largely consistent with our primary analysis with one key exception; more direct 47 care hours per patient day were associated with a lower probability of COVID-19 deaths (-4 

Fresh Data Shows Heavy Coronavirus Death Toll in Nursing 68

Driven to tiers: socioeconomic and racial 70 disparities in the quality of nursing home care. The Milbank Quarterly

Separate and unequal: racial segregation 73 and disparities in quality across US nursing homes