Is There a Relationship Between Admissions, PPE, and COVID-19 Deaths?

Two research articles were published this month in the Journal of the American Geriatrics that highlight how the administration of long-term care facilities impacted the way in which COVID-19 was managed.

In the first study, Diane M Gibson and Jessica Greene¹ examined the relationship of Personal Protective Equipment (PPE) and staffing shortages from June 7, 2020 to March 7, 2021, using nursing home admission to determine if there was a relationship between facilities having less than one week supply of PPE and insufficient numbers of staff in that week. Mandatory reporting of COVID-19 residents had been instituted on May 25, 2020. They concluded that nearly 40% of US long-term care facilities admitted one or more COVID-19 positive residents during at least one week in which they were experiencing PPE or staffing shortages.

In general, the researchers found that facilities who admitted new COVID-19 positive residents despite having staffing and/or PPE shortages generally had lower Centers for Medicare & Medicaid Services (CMS) 5-Star ratings. Ms Gibson and Ms Greene concluded that facilities experiencing these shortages who admitted COVID-19 positive residents placed both the residents and the staff at heightened risk for contracting the virus.

In a related article, Matlin Gilman and Mary T Bassett² examined the number of COVID-19 confirmed and suspected cases as well as deaths from long-term care facilities from May 25, 2020 to December 20, 2020, comparing those data with an acuity index which captured functional and cognitive impairment as well as the CMS 5-Star ratings.

They concluded that long-term care facilities with higher rates of COVID-19 admissions tended to be larger on average and had worse resident outcomes as noted by the acuity scores. These facilities also had higher proportions of non-white residents, were located in counties with high prevalence rates of COVID-19 transmission, had lower 5-Star ratings, and were more often for-profit entities.

Of note, the researchers found a correlation between lower case-mix adjusted nursing PPD (per patient day) and more citations for infection control-related issues for these providers compared to long-term care facilities where lower numbers of COVID-19 residents had been admitted.

Overall, the common findings from both studies were: relationships increased between COVID-19 transmission and lower levels of staff, and facilities experienced an impact on 5-Star ratings. This has long been a struggle for providers who need to balance the census, the staffing, and the outcomes of residents with their budgetary requirements. The need to do so is even greater now given the results of these studies.

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References:

1. Gibson DM, Green J. Admissions of COVID-positive patients to US nursing homes with personal protective equipment of staffing shortages. J Am Geriatr Soc. 2021; 60(9):2393-2403. doi:10.1111/jgs.17302
2. Gilman, M, Bassett MT. Characteristics and quality of nursing homes reporting COVID-19 admissions from hospitals. J Am Geriatr Soc. 2021; 60(9):2440-2441. doi:10.1111/jgs.17287