LAUSR

Objectives In the United States, nursing facility residents comprise less than 1% of the population but over 40% of deaths due to COVID-19. Mitigating the enormous risk of COVID-19 to nursing home residents requires adequate data. The widely used CMS COVID-19 Nursing Home Dataset contains two derived statistics: Total Resident Confirmed COVID-19 Cases per 1,000 Residents and Total Resident COVID-19 Deaths per 1,000 Residents. These metrics provide a misleading picture, as facilities report cumulative counts of cases and deaths over different time periods but use a point-in-time measure as proxy for number of residents (number of occupied beds in a week), resulting in inflated statistics. We propose an alternative statistic to better illustrate the burden of COVID-19 cases and deaths across nursing facilities. Design Retrospective cohort study. Setting and Participants Using the CMS Nursing Home Compare and COVID-19 Nursing Home Datasets, we examined facilities with star ratings and COVID-19 data passing quality assurance checks for each reporting period from May 31-August 16, 2020 (n=11,115). Methods We derived an alternative measure of the number of COVID-19 cases per 1,000 residents using the net change in weekly census. For each measure, we compared predicted number of cases/deaths by overall star rating using negative binomial regression with constant dispersion, controlling for county-level cases per capita and nursing home characteristics. Results The average number of cases per 1,000 estimated residents using our method is lower compared to the metric using occupied beds as proxy for number of residents (44.8 compared to 66.6). We find similar results when examining number of COVID-19 deaths per 1,000 residents. Conclusions and Implications Future research should estimate the number of residents served in nursing facilities when comparing COVID-19 cases/deaths in nursing facilities. Identifying appropriate metrics for facility-level comparisons is critical to protecting nursing home residents as the pandemic continues.