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Abstract
Abstract
Objective
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 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 1 confirmed case (or death) in the facility, and with the
count of cases (deaths) among facilities with at least 1 confirmed case (death).
Results
The average number of confirmed cases was 8 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 1 confirmed case, every 20 minutes (per resident day)
increase in RN staffing was associated with 22% fewer confirmed cases (incidence rate
ratio [IRR]=0.78, 95% confidence interval [CI] 0.68‐0.89, p<0.001); compared to 1‐
to 3‐star facilities, 4‐ or 5‐star facilities had 13% fewer confirmed cases (IRR=0.87,
95% CI 0.78‐0.97, p<0.015); and facilities with high concentration of Medicaid residents
(IRR=1.16, 95% CI 1.02‐1.32, p=0.025) or racial/ethnic minority residents (IRR=1.15,
95% CI 1.03‐1.29, p=0.026) had 16% and 15% more confirmed cases, respectively, than
their counterparts. Among facilities with at least 1 death, every 20 minutes increase
in RN staffing significantly predicted 26% fewer COVID‐19 deaths (IRR=0.74, 95% CI
0.55‐1.00, p=0.047). Other focused characteristics did not show statistically significant
associations with deaths.
Conclusions
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.