Table 1. Skilled Nursing Facility and Resident Characteristics by COVID-19 Exposure Status as of June 30, 2020.
| Active outbreak in June 30, 2020 (active COVID-19 SNFs), % | No outbreak by June 30, 2020 (no known COVID-19 SNFs), % | |
|---|---|---|
| SNF characteristics | ||
| SNFs, No. | 6935 | 7239 |
| For profit | 75.0 | 65.4 |
| Not-for-profit | 20.2 | 26.5 |
| Public | 4.7 | 8.1 |
| Urbana | 85.5 | 59.3 |
| No. of beds, median (IQR) | 120 (90-150) | 83 (57-115) |
| Part of a chain | 56.9 | 58.6 |
| Hospital based | 2.2 | 6.1 |
| Region | ||
| South | 35.9 | 33.9 |
| Northeast | 25.5 | 9.5 |
| Midwest | 23.3 | 41.5 |
| West | 15.3 | 15.0 |
| Overall Medicare star rating, mean (SD)b | 3.26 (1.4) | 3.39 (1.4) |
| County-level COVID-19 prevalence per 1000 beneficiaries, mean (SD)c | 1.29 (2.44) | 0.47 (0.62) |
| LTC resident characteristics | ||
| Residents, No. | 451 572 | 340 094 |
| Age, median (IQR), y | 80 (73-89) | 82 (73-89) |
| ≤64 | 11.0 | 9.5 |
| 65-79 | 36.4 | 33.0 |
| ≥80 | 52.6 | 57.4 |
| Women | 64.8 | 67.0 |
| Men | 35.2 | 33.0 |
| Medicaid dual eligible | 66.8 | 61.1 |
| Disabled without ESRD | 10.8 | 9.4 |
| Fraild | 19.4 | 20.3 |
| Dementiae | 56.6 | 55.4 |
| No. of chronic conditions, median (IQR)f | 5 (1-8) | 5 (1-7) |
| Race and ethnicity | ||
| Hispanic | 7.9 | 4.1 |
| Non-Hispanic Black | 19.0 | 8.9 |
| Non-Hispanic White | 69.0 | 84.1 |
| Other or unknowng | 4.1 | 2.9 |
Abbreviations: ESRD, end-stage renal disease; LTC, long-term care; SNF, skilled nursing facility.
Urban was defined as a patient residing in a metropolitan zip code. Urban locations were identified using the Health Resources and Service Administration rural-urban commuting area code database (http://depts.washington.edu/uwruca/index.php).
Medicare star ratings range from 1 (much below average) to 5 (much above average). This score is a composite ranking of individual SNFs that incorporates multiple measures of SNF quality, staffing, and health inspection performance.
COVID-19 cases were defined using publicly available data from the New York Times COVID-19 database (https://github.com/nytimes/covid-19-data). Cumulative county-level cases as of November 2020 were tabulated and normalized per 100 residents in each county.
Frailty was defined using a previously validated claims-based frailty index from Kim et al.23,28 Patients in the top 10% of the frailty index over the entire population of SNF admissions were classified as frail.
Dementia was defined using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes described in Goodman et al.24
The presence of 27 conditions was gathered from the Chronic Condition Data Warehouse (CCW), which uses claims since 1999 to describe Medicare beneficiaries’ accumulated chronic disease burden. Chronic conditions were defined as any condition present by the end of the calendar year. Conditions included Alzheimer disease, Alzheimer disease and related disorders or senile dementia, anemia, asthma, atrial fibrillation, benign prostatic hyperplasia, breast cancer, cataract, chronic kidney disease, chronic obstructive pulmonary disease, colorectal cancer, depression, diabetes, endometrial cancer, glaucoma, heart failure, hip or pelvic fracture, hyperlipidemia, hypertension, hypothyroidism, ischemic heart disease, lung cancer, osteoporosis, prostate cancer, acute myocardial infarction, rheumatoid arthritis, and stroke or transient ischemic attack.
“Other” race options at Medicare enrollment included American Indian or Alaska Native; Asian; Native Hawaiian or Pacific Islander. Less than 1% of beneficiaries are coded as “unknown” race.