An Examination of COVID-19 Mortality in High-Minority Nursing Homes
Abstract
Research Objective
Racial/ethnic disparities in healthcare have been highlighted by the recent COVID-19 pandemic. Using the Centers for Medicare and Medicaid Services’ Nursing Home COVID-19 Public File, we examined the relationship between nursing home racial/ethnic mix and COVID-19 resident mortality. Additionally, we examined the effects of resident characteristics, market resource availability, and organizational characteristics as it relates to nursing home racial/ethnic disparities in COVID-19 mortality.
Study Design
Multivariate regressions were used to model the relationship between COVID-19 deaths and the proportion of racial/ethnic minority residents (Black and Hispanic residents). Given the over-dispersion of the count dependent variable (number of COVID-19 deaths), negative binomial regressions were used. We used four nested sequential models to examine the separate contributions of facility-level resident characteristics, resource availability, and other organizational characteristics to racial/ethnic disparities in COVID-19 deaths. In addition, we controlled for size and interstate differences using state fixed effects.
Population Studied
The study sample consisted of all US nursing homes included in the CMS Nursing Home COVID-19 Public File, or 15,382 nursing homes, which mirrors the national census of facilities.
Principal Findings
As of October 25, 2020, high minority nursing homes reported 6.5 COVID-19 deaths as compared to 2.6 deaths for nursing homes that had no racial/ethnic minorities. After controlling for interstate differences, facility-level resident characteristics, resource availability, and organizational characteristics, high-minority nursing homes had 61% more COVID-19 deaths (Incidence Rate Ratio [IRR] = 1.61; p < 0.001) as compared to nursing facilities with no minorities.
Conclusions
From a policy perspective, nursing homes, that serve primarily minority populations, may need additional resources, such as, funding for staffing and personal protective equipment in the face of the pandemic. The COVID-19 pandemic has sharpened the focus on healthcare disparities and societal inequalities in the delivery of long-term care.
Implications for Policy or Practice
This study shows the disparate effect that COVID-19 has had on nursing home mortality based on resident racial/ethnic mix. Even after controlling for interstate differences, facility-level resident characteristics, resource availability, and organizational characteristics, high-minority nursing homes had almost three times the probability of having COVID-19 deaths compared to those with no minorities. These findings highlight the existing and systemic health disparities in nursing homes and the tangible impact it has on racial/ethnic minorities. Death due to COVID-19 is greater risk for racial/ethnic minorities in nursing homes relative to White residents. Nursing homes that serve larger minority populations may need additional resources to combat this crisis.
