ABSTRACT
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.
Subject(s)
COVID-19 , Skilled Nursing Facilities , Aged , COVID-19/epidemiology , Ethnicity , Humans , Illinois/epidemiology , Medicare , Minority Groups , Pandemics , United States/epidemiologyABSTRACT
The COVID pandemic disrupted the way evidence-based health promotion programs (EBPs) are delivered to older adults who were the most at-risk group in terms of mortality and faced unprecedented threats to their independence and physical and mental health. Many organizations stopped in-person EBPS causing older adults to lose access to key social networks and health resources. It is a top public health priority to find new ways to keep older adults connected to their EBPs. Fit & Strong! (F&S!) is a group exercise/health education EBP for older adults with arthritis offered by CBOs in 32 states. CBOs stopped offering F&S! in-person in March 2020. Since the lockdown, we have worked closely with our provider network to develop and pilot a version that is remote/online and live, titled “F&S! @Home”. Instructors deliver F&S! @Home to older adults with minimal technological resources. We created a staging website for both providers/instructors and participants that is used to initiate the classes, enable providers to manage participants, collect data, and share support materials. The pilot began September 2020;since that time 15 classes have been offered to 147 participants. Administration on Community Living falls and arthritis outcomes data are being collected. Preliminary analyses of 45 participants and 8 instructors demonstrate a high rating of the program (mean score of 90.2 out of 100) with no adverse outcomes to date. This presentation will review the process of creating the online adaptation, lessons learned, and will review pre/post outcomes and participant and instructor evaluation feedback.
ABSTRACT
Investigators at the University of Illinois Chicago, the Illinois Department on Aging (IDOA), the Illinois Department of Public Health, and the Health and Medicine Policy Research Group are collaborating to examine comparative rates of Covid-19-related deaths among older adults who reside in nursing homes vs. the community in Illinois. As a first step, we have examined data from the Cook County Medical Examiner’s office to compare nursing home resident fatalities to those who died in the community. Deaths with Covid-19 listed as primary or secondary cause of death that occurred between January 1, 2020 to September 30, 2020 among older adults ages 60 and over were identified from the Cook County Medical Examiner’s Office case archive file. Location at death and race/ethnicity were obtained from the same source. Location at death was matched with data in the Center for Medicare and Medicaid Services (CMS) Covid-19 Nursing Home Data to identify persons who died in skilled nursing facilities (SNFs) as well as facility and staff characteristics. We found that the 3,937 deaths among persons over the age of 60 comprised 75% of total deaths in Cook County. Of the total older adult deaths, 2,090 (53%) died in the community and 1,837 (47%) died in SNFs. Regression analyses that controlled for CMS quality ratings found that larger, for-profit nursing homes, with high levels of staff infected with Covid-19 were associated with higher mortality. The policy implications of these findings will be discussed.