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.

COVID-19 Nursing Home Deaths in Cook County: Predictors and Modifiable Risks

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.