Many nursing home residents who have not contracted or died from COVID-19 have also suffered negative consequences during the pandemic. Loneliness and isolation have taken a significant toll on residents. A study of long-stay residents in Connecticut’s 244 nursing homes finds that, compared with residents in the same four-month period (March 9-July 31) in 2017-2019, residents in 2020 experienced increased depression, unplanned weight loss, and incontinence, as well as deterioration in cognitive function. The researchers at Mathematica who did the study found no differences in serious pressure ulcers, activities of daily living, recent falls, urinary tract infections, or use of antipsychotic or anti-anxiety medications.[1]
The study’s authors identify selection bias in the assessment data that could have affected their findings. They note that the 10 percent of residents living in Connecticut nursing facilities in March 2020 who died could have experienced declines in their mental and physical functioning that were not recorded in the data and that, as a result, the study may have underestimated the negative health effects of the pandemic on residents.
The Center notes that Mathematica’s analysis may understate the negative effects of the pandemic for another reason. Analysis of resident outcomes depends on the accuracy of resident assessment data. A recent study found that skilled nursing facilities (SNFs) under-reported the three quality measures they studied, which are three of the six measures where the Mathematica researchers found no decline in Connecticut nursing home residents.
Comparing pressure ulcer rates reported by SNFs with pressure ulcer rates from patients who were readmitted to the hospital from the SNFs, Integra Med Analytics found that SNFs under-reported three quality measures – pressure ulcers, urinary tract infections (UTIs), and falls.[2] The researchers found “low correlations between self-reported and hospital-based measures for pressure ulcers, UTIs and falls at .02, .04 and .09 respectively, indicating that the self-reported measures were inconsistent with hospital-based diagnoses.”
Integra Med Analytics reports, “The median ratio of the self-reported and hospital-based pressure ulcer rates was 0.48, indicating that over half of SNFs under-reported by at least a factor of two.” The researchers describe their analysis as “a conservative measure of under-reporting; the hospital data only included patients that were re-admitted to the hospital in the numerator and any SNF patients with pressure ulcers that were not re-admitted to the hospital weren’t counted.”
The consequences of under-reporting were significant. One facility studied by the company “had a low self-reported UTI rate of less than 1 in 1,000 which is in the first percentile of the self-reported rates. However, 5.8% of this SNF’s admissions were re-hospitalized with a UTI, which is in the 86th percentile for the hospital-based measure.”
[1] Michael Levere, Patricia Rowan, Andrea Wysocki, “The adverse events of the COVID-19 pandemic on nursing home resident well-being,” Journal of the American Medical Directors Association (2021), https://www.jamda.com/article/S1525-8610(21)00306-6/pdf
[2] Integra Med Analytics, Underreporting in Nursing Home Quality Measures (Aug. 2020), https://www.nursinghomereporting.com/post/underreporting-in-nursing-home-quality-measures.