Hong S, Mejía ST
Objective
Disadvantages accumulated over the span of residents’ lives before nursing home placement can compound within nursing homes, potentially amplifying the effects of those disadvantages on resident outcomes. This study examined the extent to which nursing home location and ownership differentiated the outcome trajectories and susceptibility to the impact of momentary threats, the time-varying stressors that can influence COVID-19 outcomes during a specific period.
Methods
The COVID-19 Nursing Home Data provided weekly reports of COVID-19 infections and deaths from June 2020 to January 2021 from 11,088 nursing homes. Nursing homes were categorized by for-profit vs. not-for-profit ownership and rural vs. urban location. Momentary threats included the nursing home and county-level COVID-19 infection rate and staff shortage. Multilevel multinomial negative binomial regression nested weekly observations within nursing homes and tested the impact of nursing home factors on the trajectory and momentary threats.
Results
COVID-19 infection/mortality rates were higher in for-profit than in non-profit nursing homes, showing worsening disparities over time. At baseline, rural nursing homes had lower COVID-19 infection/mortality rates than urban nursing homes, but rural nursing homes reported higher rates than urban nursing homes over time. Weekly county-level COVID-19 infection had stronger impacts in rural nursing homes. However, the impact of weekly variation in nursing home COVID-19 infections on deaths was smaller in for-profit and rural nursing homes.
Conclusion
This study revealed cumulative disadvantage of nursing home characteristics in COVID-19 infections and deaths, implying the importance of addressing inequalities in prevention and control of COVID-19 within nursing homes.