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Pandemic-Related Health, Quality of Life Declines in Residents of U.S. Skilled Nursing Facilities

During the first year of the SARS-CoV-2 pandemic, mortality increased and functionality declined in residents of skilled nursing facilities (SNFs) with active COVID-19 cases, researchers report. Residents had significantly increased weight loss and depressive symptoms during 2020, regardless of the facility’s COVID-19 status.

In this retrospective observational study, U.S. Medicare claims and Minimum Data Set 3.0 submissions for 2020 were compared with records from 2018 and 2019, with each SNF serving as its own control. Among facilities with COVID-19 cases in 2020, mortality increased by 1.60% over a 2.2% rate in the prior 2 years. Hospitalizations were up by 0.10%, and visits to the emergency departments declined by 0.57%; the respective figures for the prior 2 years were 3.0% and 2.9%. All changes were statistically significant.

In contrast, SNFs with no known COVID-19 cases in 2020, mortality rates decreased significantly by 0.15%, hospitalizations by 0.83%, and emergency department visits by 0.79%. “The cause of this decrease in mortality is unclear, but some of the decrement may be attributable to tight infection control policy that likely reduced transmission of other nosocomial infections, a chronic problem in SNFs predating the COVID-19 pandemic,” write the authors. “There are other plausible mechanisms. For example, increased isolation may have also limited resident mobility in nursing homes, leading to both fewer falls and worse quality of life outcomes.” The decrease in mortality despite fewer hospital and emergency department visits suggests that “some hospital use in SNFs has little mortality benefit,” the researchers write.

“In 2018-2019, across all SNFs, residents required assistance with an additional 0.89 [activities of daily living (ADLs)] between January and November, and lost 1.9 lb; 27.1% had worsened depressive symptoms,” the investigators add. “In 2020, residents in active COVID-19 SNFs required assistance with an additional 0.36 ADLs (95% CI, 0.34 to 0.38), lost 3.1 lb (95% CI, −3.2 to −3.0 lb) more weight, and were 4.4% (95% CI, 4.1% to 4.7%) more likely to have worsened depressive symptoms, all statistically significant changes. In 2020, residents in no-known COVID-19 SNFs had no significant change in ADLs (−0.06 [95% CI, 0.12 to 0.01]), but lost 1.8 lb (95% CI, −2.1 to −1.5 lb) more weight and were 3.2% more likely (95% CI, 2.3% to 4.1%) to have worsened depressive symptoms, both statistically significant changes.”