Short-stay admissions and lower staffing associated with larger COVID-19 outbreaks in Maryland nursing homes

ObjectivesIdentify facility factors associated with a larger COVID-19 outbreak among residents in Maryland nursing homes (NHs). DesignObservational Setting and ParticipantsAll Maryland NHs. MethodsResident COVID-19 cases were collected for each Maryland NH from January 1, 2020 through July 1, 2020. Cumulative COVID-19 incidence through July 1, 2020 was collected for each county and Baltimore City. Facility characteristics for each Maryland NH were collected from time periods prior to January 1, 2020. NH outbreaks were defined as larger when total resident COVID-19 cases exceeded 10% of licensed beds. Descriptive and multivariable analyses were conducted to assess the strongest predictors for the primary outcome of larger COVID-19 outbreak. ResultsNHs located in counties with high cumulative incidence of COVID-19 were more likely to have larger outbreaks (OR 4.5, 95% CI 2.3-8.7, p<0.01). NHs with at least 100 beds were more likely to have larger outbreaks, especially among facilities with >140 licensed beds (100-140 beds vs <100 beds: OR 1.9, 95% CI 0.9-4.1, p=0.09; >140 beds vs <100 beds: OR 2.9, 95% CI 1.3-6.1, p<0.01). NHs with more short-stay residents (OR 2.2, 95% CI 1.1-4.8, p=0.04) or fewer Certified Nursing Assistant hours daily (OR 2.6, 95% CI 1.3-5.3, p<0.01) also were more likely to have larger outbreaks. Resident race and gender were not significant predictors of larger outbreaks after adjustment for other factors. ConclusionsLarge NHs with lower staffing levels and many short-stay residents in counties with high COVID-19 incidence were at increased risk for COVID-19 outbreaks. Understanding the characteristics of nursing homes associated with larger outbreaks can help us prepare for the next pandemic. Brief summaryMaryland nursing homes in counties with a high COVID-19 incidence, more licensed beds, a higher proportion of short-stay residents, or lower CNA staffing hours were more likely to have a larger outbreak early in the pandemic.