Quality Ratings and COVID: What’s the Relationship?
8/1/2020
One message is clear from the pandemic: The coronavirus doesn’t discriminate. Not even Centers for Medicare & Medicaid Services Five-Star-rated nursing facilities are exempt. This was documented by a recent study out of Miami University of Ohio, in which authors found no link between having a resident positive for COVID-19 and the facility’s star rating in Ohio nursing facilities.
Researchers also found no link between star rating and having a high number of COVID-positive residents. They concluded that having residents with COVID-19 is by no means an indicator of poor quality or inadequate care.
At the same time, another study published in the Journal of the American Geriatrics Society (JAGS) suggested that nursing facilities in Connecticut with Five-Star ratings were less likely to have COVID-19 cases and deaths after adjusting for facility size and patient race proportion. These different perspectives point to the fact that there are still many unknowns about COVID and that reliable and tested methods to assess facilities’ pandemic response are needed.
Contributing Factors
John Bowblis, PhD, lead author on the Ohio study highlights, says, “It’s easy to blame the nursing home because a lot of COVID is happening there. But people need to understand what was happening in the facility and the available knowledge about the virus when the facility had its first positive COVID resident.”
For instance, he says, “Early on, we thought that if we checked temperatures before allowing people to come into the facility, that was enough. We later learned that it wasn’t. We need to educate people about what the research and scientific knowledge was at the time and what facilities did using that as a standard.”
A JAGS study out of the University of Rochester suggested that higher registered nurse (RN) staffing is associated with a reduced number of nursing facility COVID cases and death. The authors determined that among facilities with at least one confirmed case, a 20-minute increase in RN staffing per resident day was related to a significant decrease in confirmed cases.
There are still questions about the impact of staffing on COVID-related outcomes. “Staffing levels can change from year to year, and real-time staffing data are not available,” Bowblis says. The authors utilized staffing patterns from late 2019 and found that staffing levels didn’t have much effect on COVID rates.
“We hypothesized that more agency staff would coincide with more cases of COVID, but we didn’t find our data supported this,” he says. He also cites some interesting data about staffing and COVID coming out of the federal government. “We analyzed these data and found that if there were COVID cases in a facility, that location was more likely to report staff shortages. Lack of PPE was also related to self-reported staffing problems,” he says. “This could be because more staff got sick or were afraid that they would get sick.”
Either way, he suggests, this emphasizes a real connection between adequate PPE and a facility’s ability to adequately respond to an outbreak.