Changes in Health and Quality of Life in US Skilled Nursing Facilities by COVID-19 Exposure Status in 2020

IMPORTANCE: During the COVID-19 pandemic, the US federal government required that skilled nursing facilities (SNFs) close to visitors and eliminate communal activities. Although these policies were intended to protect residents, they may have had unintended negative effects. OBJECTIVE: To assess hea...

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Bibliographic Details
Published in:JAMA : the journal of the American Medical Association 2022-09, Vol.328 (10), p.941-950
Main Authors: Barnett, Michael L, Waken, R. J, Zheng, Jie, Orav, E. John, Epstein, Arnold M, Grabowski, David C, Joynt Maddox, Karen E
Format: Article
Language:English
Subjects:
Activities of Daily Living
Aged
Body weight
Body weight loss
Comments
Coronaviruses
COVID-19
COVID-19 - diagnosis
COVID-19 - epidemiology
COVID-19 - prevention & control
COVID-19 Testing
COVID-19 Vaccines
Diagnosis
Emergency medical care
Emergency medical services
Environmental Exposure - statistics & numerical data
Federal government
Government programs
Health Policy
Health Status
Humans
Medicare - statistics & numerical data
Mental depression
Mortality
Nurses
Nursing
Online First
Original Investigation
Pandemics
Pandemics - statistics & numerical data
Quality of Life
Retrospective Studies
Skilled Nursing Facilities - statistics & numerical data
Statistical analysis
United States - epidemiology
Vaccination
Weight loss
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Summary:IMPORTANCE: During the COVID-19 pandemic, the US federal government required that skilled nursing facilities (SNFs) close to visitors and eliminate communal activities. Although these policies were intended to protect residents, they may have had unintended negative effects. OBJECTIVE: To assess health outcomes among SNFs with and without known COVID-19 cases. DESIGN, SETTING, AND PARTICIPANTS: This retrospective observational study used US Medicare claims and Minimum Data Set 3.0 for January through November in each year beginning in 2018 and ending in 2020 including 15 477 US SNFs with 2 985 864 resident-years. EXPOSURES: January through November of calendar years 2018, 2019, and 2020. COVID-19 diagnoses were used to assign SNFs into 2 mutually exclusive groups with varying membership by month in 2020: active COVID-19 (≥1 COVID-19 diagnosis in the current or past month) or no-known COVID-19 (no observed diagnosis by that month). MAIN OUTCOMES AND MEASURES: Monthly rates of mortality, hospitalization, emergency department (ED) visits, and monthly changes in activities of daily living (ADLs), body weight, and depressive symptoms. Each SNF in 2018 and 2019 served as its own control for 2020. RESULTS: In 2018-2019, mean monthly mortality was 2.2%, hospitalization 3.0%, and ED visit rate 2.9% overall. In 2020, among active COVID-19 SNFs compared with their own 2018-2019 baseline, mortality increased by 1.60% (95% CI, 1.58% to 1.62%), hospitalizations decreased by 0.10% (95% CI, −0.12% to −0.09%), and ED visit rates decreased by 0.57% (95% CI, −0.59% to −0.55%). Among no-known COVID-19 SNFs, mortality decreased by 0.15% (95% CI, −0.16% to −0.13%), hospitalizations by 0.83% (95% CI, −0.85% to −0.81%), and ED visits by 0.79% (95% CI, −0.81% to −0.77%). All changes were statistically significant. In 2018-2019, across all SNFs, residents required assistance with an additional 0.89 ADLs between January and November, and lost 1.9 lb; 27.1% had worsened depressive symptoms. In 2020, residents in active COVID-19 SNFs required assistance with an additional 0.36 ADLs (95% CI, 0.34 to 0.38), lost 3.1 lb (95% CI, −3.2 to −3.0 lb) more weight, and were 4.4% (95% CI, 4.1% to 4.7%) more likely to have worsened depressive symptoms, all statistically significant changes. In 2020, residents in no-known COVID-19 SNFs had no significant change in ADLs (−0.06 [95% CI, −0.12 to 0.01]), but lost 1.8 lb (95% CI, −2.1 to −1.5 lb) more weight and were 3.2% more likely (95% CI, 2.3% to
ISSN:0098-7484
1538-3598
DOI:10.1001/jama.2022.15071