(25) Nursing Home Facility Characteristics and Occurrence of Severe COVID-19 Outcomes Among U.S. Medicare Beneficiaries Ages 65 and Older in The Vaccine Era

Publication Number: 1070

Background: Recently published observational studies in the pre-vaccine pandemic period have suggested the importance of nursing home (NH) characteristics (e.g., quality, crowding) on the risk of severe COVID-19 outcomes among NH residents.

Objectives: To comprehensively evaluate NH facility risk factors for COVID-19 infections and severe COVID-19 outcomes (i.e., hospitalizations, deaths) among NH residents ages 65 and older following COVID-19 vaccine authorization during pre-Delta and Delta variant periods.

Methods: In this retrospective cohort study of Medicare fee-for-service beneficiaries aged ≥65 years residing in NHs, we evaluated effects of both individual- and facility-level characteristics on residents’ COVID-19 outcome risk during December 2020-November 2021. Facility-level covariates included NH quality measures, health inspection ratings, staffing levels, ownership type, staff and resident vaccination rates, number of residents per day, percent of beds occupied and residents’ health status (e.g., proportion of residents with cognitive impairment, high frailty and comorbidity). Outcomes included medically attended COVID-19 infections, hospitalizations, and deaths based on ICD-10-CM diagnosis code U07.1 either during medical encounters, hospitalizations, or within 21 days prior to death. We summarized individual- and facility-level characteristics and estimated adjusted hazard ratios (HRs) using multivariate Cox proportional hazards regressions.

Results: The study identified 14,188 NHs and 557,573 elderly NH residents. At the beginning of the vaccine study period (December 2020), NH bed occupancy rates varied greatly across facilities, between 58.0% and 79.3% for half of the NHs, and with a median of 69.2%. Approximately a third of the facilities (33.8%) had an above-average health inspection rating (≥4), and 61.7% had an above-average quality measure rating. 70.6% of the NHs were for-profit facilities. By August 21, 2021, median NH resident and staff vaccination rates were 87.3% and 63.2%. Adjusted HRs will be presented to assess the impact of NH facility-level characteristics on risk of severe COVID-19 outcomes in the vaccine era while controlling for individual-level risk factors.

Conclusions: In this ongoing large-scale study, we assess a range of NH facility characteristics (e.g., staff and resident vaccination rates, quality ratings, ownership type, staffing hours, bed occupancy) that may significantly impact the spread of COVID-19 after the vaccine introduction in the most vulnerable population in the U.S.