COVID-19 Cases and Deaths in Skilled Nursing Facilities in Cook County, Illinois

Objective: The COVID-19 pandemic has had a devastating impact on older adults residing in skilled nursing facilities. This study examined the pathways through which community and facility factors may have affected COVID-19 cases and deaths in skilled nursing facilities. Methods: We used structural equation modeling to examine the number of COVID-19 cases and deaths in skilled nursing facilities in Cook County, Illinois, from January 1 through September 30, 2020. We used data from the Centers for Medicare & Medicaid Services, the Illinois Department of Public Health, and the Cook County Medical Examiner's Office to determine the number of resident COVID-19 cases and deaths, number of staff cases, facility-level characteristics, and community-level factors. Results: Poorer facility quality ratings and higher numbers of staff COVID-19 cases were associated with increased numbers of resident COVID-19 cases and deaths. For-profit ownership was associated with larger facilities and higher resident-to-staff ratios, which increased the number of staff COVID-19 cases. Furthermore, skilled nursing facilities with a greater percentage of White residents were in areas with lower levels of social vulnerability and were less likely to be for-profit and, thus, were associated with higher quality. Conclusions: For-profit ownership was associated with lower facility quality ratings and increases in the number of staff COVID-19 cases, leading to increased resident COVID-19 cases and deaths. Establishing enforceable regulations to ensure quality standards in for-profit skilled nursing facilities is critical to prevent future outbreaks and reduce health disparities in facilities serving racial and ethnic minority populations.

Automated summary

This study examined the impact of community and facility factors on COVID-19 cases and deaths in skilled nursing facilities. The findings showed that poorer facility quality ratings and higher numbers of staff COVID-19 cases were associated with increased resident COVID-19 cases and deaths. For-profit ownership was linked to larger facilities, higher resident-to-staff ratios, and increased staff COVID-19 cases. Skilled nursing facilities with a higher percentage of White residents were located in areas with lower social vulnerability and were less likely to be for-profit, resulting in higher facility quality.