Image of Sheryl Zimmerman, Ph.D.

Facilities that incorporate the Green House/small nursing home model have faced significantly lower rates of COVID-19 cases, admissions and mortality than traditional nursing homes, according to research published in the March issue of JAMDA.

The study included 43 organizations overseeing 219 facilities. The small-home model had fewer COVID-19 cases when compared with both smaller traditional nursing homes (less than 50 beds), and with larger traditional settings (50 beds or more), the researchers reported. 

Differences were most notable among the outliers, wrote lead author Sheryl Zimmerman, Ph.D., of the University of North Carolina at Chapel Hill. Only one-quarter of Green House/small nursing homes had COVID-19 case rates per 100 resident years higher than 2.92, but the corresponding rates for traditional nursing homes ranged from 5.48 and 27, she and her colleagues found.

Although small facility size is known to limit the proportion of COVID-19 cases, aspects of Green House/small nursing homes may provide infection control benefits beyond mere size, the authors contend. These may include private bedrooms and bathrooms, limited ancillary staff and fewer admissions. 

“In fact, small traditional nursing homes (less than 50 beds) were not as advantaged in terms of COVID-19 admissions as were Green House/small nursing homes,” Zimmerman wrote.

Other factors that may have affected the results include the lower number of for-profit facilities among Green House nursing homes (18% compared with 69% in traditional) and better pay for certified nursing assistants, which may result in fewer staff working in more than one job, the authors said. Green House/small nursing home facilities also have fewer residents who are at higher mortality risk, which may skew the results, and fewer residents who are bed-bound and catheterized, which may further explain differences in COVID-19 mortality rates, they added.