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A nursing home’s own neighborhood may have less impact on COVID deaths than staffs’ home communities.

Where nursing home staff live is a “large and significant predictor” of which facilities will experience a COVID-19 outbreak in a given county, Harvard researchers say.

In a paper awaiting peer review, investigators analyzed data on facility COVID deaths and staff neighborhood factors across 18 states. Within the same county, significantly more deaths due to COVID were found in nursing homes whose staff lived in denser, less-white communities with more public transportation use, reported Karen Shen, a Ph.D. candidate from Harvard’s department of economics. The finding amounted to approximately one additional COVID death per 100 beds.

In addition, staff neighborhood characteristics had a greater impact on COVID deaths than facility management variables, quality ratings, and a nursing home’s own neighborhood characteristics, she added.

The study provides further evidence that COVID outbreaks in nursing homes do not occur randomly, and that where staff live is likely an important source of infection, Shen concluded. The paper was highlighted in a recent tweet by leading long-term care policy expert David Grabowski, Ph.D., of Harvard Medical School.

Full findings were published in the online preprint server medRxiv.