Is There a Link between Nursing Home Reported Quality and COVID-19 Cases? Evidence from California Skilled Nursing Facilities

Objectives: During the Coronavirus disease 2019 (COVID-19) outbreak in the United States, nursing homes became the hotbed for the spread of COVID-19. States developed different policies to mitigate the COVID-19 risks at nursing homes, including limiting nursing home visitation and mandating staff screening. The purpose of this study is to examine whether COVID-19 cases and deaths are related to the nursing home reported quality. Design: We combined the COVID-19 data reported by the California Department of Public Health, quality ratings provided by Nursing Home Compare, and patient racial information from Long-Term Care Focus to examine the association between nursing home reported quality and COVID-19 cases and deaths. Settings and Participants: Cross-sectional data from 1223 California skilled nursing facilities with reported quality and longitudinal data of COVID-19 cases were used. Methods: The dependent variable is COVID-19 residents' cases and deaths. The main independent variable is nursing home reported quality. Nursing home ownership, size, years of operation, and patient race composition are also included. Results: Nursing home star ratings and greater percentage of residents from different racial and ethnicity groups were significantly (P < .01) related to increased probability of having a COVID-19 residents' case or death. Conclusions and Implications: Nursing homes with 5-star ratings were less likely to have COVID-19 cases and deaths after adjusting for nursing home size and patient race proportion. (C) 2020 The Author(s). Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).