The Center for Medicare Advocacy (CMA) released a report stating that multiple factors contributed to the spread of COVID-19 in skilled nursing facilities. CMA is a non-profit law organization that advocates for Medicare beneficiaries. CMA argued that geography was not the only factor. The Journal of the American Geriatrics Society published an article stating that community spread was the top predictor of COVID-19 outbreaks.
The report by CMA examined a number of factors that led to COVID-19 outbreaks in skilled nursing facilities including CMS ratings, availability of COVID-19 testing for residents and staff, ownership and personal protective equipment (PPE). It was concluded that nursing homes with five-star ratings were 18% more effective at preventing COVID-19 outbreaks. Five-star nursing homes had an average infection rate of 38% among residents, compared to 43% in four-star facilities and 45% in three, two and one-star facilities. Staff ratings also factored into the rate of infection outbreaks. Skilled nursing facilities with a CMS staffing star rating of 3.4 performed much better than those with an average staffing star rating of 3.1.
Skilled nursing facilities who had a lesser shortage of staff testing capacity also performed better than those with more of a shortage. The pattern was similar to those with nursing staff shortages. 21% of the low-performing facilities had nursing staff shortages compared to only 18.4% of the top-performing facilities. The only counterintuitive finding was the percentage of shortage of nurse aides. Top-performing facilities had a higher percentage of shortage of nurse aides at 21.2% compared to low-performing facilities with a 20.4% shortage.
Rebecca Gorges and R. Tamara Konetzka conducted a study in August 2020 concluding that higher nurse-aide hours and total nursing hours correlated with a lower chance of COVID-19 infections and therefore less deaths. However, higher registered nurse hours correlated with a higher possibility of cases. The cause could have been higher foot traffic from outside. The final conclusion was that the community cases were the strongest predictor of outbreaks inside skilled nursing facilities but higher nurse aide and total nursing hours helped contain the infection numbers.