Risk Stratification of Nursing Homes to Plan COVID-19 Responses: A Case Study of Victoria, Australia

Objective: Emergency management responses to coronavirus disease 2019 (COVID-19) in nursing homes lacked preparation and nuance; moving forward, responses must recognize nursing homes are not generic organizations or services, and individually appreciate each's unique nature, strengths, and limitations. The objective of this study was to describe an approach to stratifying nursing homes according to risk for COVID-19 outbreak. Methods: Population-based cross-sectional study of all accredited nursing homes in Victoria (n = 766), accommodating 48,824 permanent residents. We examined each home's facility structure, governance history, socio-economic status, proximity to high-risk industry, and proximity and size of local acute public hospital, stratified by location, size, and organizational structure. Results: Privately owned nursing homes tend to be larger and metropolitan-based, and publicly owned homes regionally based and smaller in size. The details reveal additional nuance, eg, privately owned metropolitan-based medium- to large-sized facilities tended to have more regulatory noncompliance, no board of governance, and fewer Chief Executive Officers with clinical background. In contrast, the smaller, publicly owned, remote facilities perform better on those same metrics. Conclusions: Nursing homes should not be regarded as generic entities, and there is significant underlying heterogeneity. Stratification of nursing homes according to risk level is a viable approach to informing more nuanced policy direction and resource allocation for emergency management responses.

Automated summary

This study describes an approach to stratifying nursing homes based on their risk for COVID-19 outbreak. The findings reveal significant heterogeneity among nursing homes, with privately owned homes being larger and located in metropolitan areas but having more regulatory noncompliance, while publicly owned homes being smaller and located in remote areas but performing better.