Nursing Home Quality, Covid-19 Deaths, and Excess Mortality

49 Pages Posted: 2 Nov 2020 Last revised: 28 Jan 2022

See all articles by Christopher Cronin

Christopher Cronin

University of Notre Dame, Department of Economics

William N. Evans

University of Notre Dame; National Bureau of Economic Research (NBER)

Date Written: October 2020

Abstract

The COVID-19 pandemic in the US has been particularly devastating for nursing home residents. A key question is how have some nursing homes been able to effectively protect their residents, while others have not? Using data on the universe of US nursing homes, we examine whether establishment quality is predictive of COVID-19 mortality. Higher-quality nursing homes, as measured by inspection ratings, have substantially lower COVID-19 mortality. Quality does not predict the ability to prevent any COVID-19 resident or staff cases, but higher-quality establishments prevent the spread of resident infections conditional on having one. Preventing COVID-19 cases and deaths may come at some cost, as high-quality homes have substantially higher non-COVID deaths, a result consistent with high excess non-COVID mortality among the elderly since March. The positive correlation between establishment quality and non-COVID mortality is driven entirely by nursing homes located in counties with below-median COVID-19 case rates. As a result, high-quality homes in these counties have significantly more total deaths than their low-quality counterparts. The concentration of excess death in low-risk areas suggests that future suffering could be avoided with more nuanced guidelines, such as those recently suggested by CMS that outline a role for in-person visits in lower-risk areas.

Suggested Citation

Cronin, Christopher and Evans, William N., Nursing Home Quality, Covid-19 Deaths, and Excess Mortality (October 2020). NBER Working Paper No. w28012, Available at SSRN: https://ssrn.com/abstract=3723250

Christopher Cronin (Contact Author)

University of Notre Dame, Department of Economics ( email )

Notre Dame, IN 46556-5646
United States

William N. Evans

University of Notre Dame ( email )

913 Flanner Hall
Notre Dame, IN 46530
United States
574-631-7039 (Phone)

National Bureau of Economic Research (NBER)

1050 Massachusetts Avenue
Cambridge, MA 02138
United States

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