Facility size, race and location — not quality ratings — are linked to COVID-19 cases and deaths in eldercare facilities, according to two studies. Industry advocates say this bolsters a case to focus less on penalties and more on appropriate aid.

A new investigation of nearly 9,400 nursing homes found that larger facility size, urban location, greater percentage of African American residents, non‐chain status, and state were significantly related to the probability of having at least one COVID‐19 case. In contrast, a five‐star rating from Nursing Home Compare, prior infection violation, Medicaid dependency, and ownership were not related, wrote David Grabowski, Ph.D., of Harvard Medical School, and colleagues.

Likewise, a 12-state University of Chicago analysis found a “strong and consistent relationship” between race and the probability of COVID-19 cases and deaths in nursing facilities. There was “no meaningful relationship between nursing home quality and COVID-cases or deaths,” researcher Tamara Konetzka, Ph.D., told the U.S. Senate in a May subcommittee meeting.

The studies have come to light as the Centers for Medicare and Medicaid Services on Monday vowed to ratchet up surveys and penalties following the release of federal data showing that nursing facilities may account for 25% of the U.S. COVID-19 deaths reported to date.

The new federal nursing home data validate the need to identify areas and facilities most in need of resources, said Mark Parkinson, president and CEO of the American Health Care Association / National Center for Assisted Living. But the infection situation in nursing homes will worsen if surveyors “are only looking for reasons to find deficiencies and issue fines” instead of helping to improve infection control programs, he said. 

“It’s time to recognize that when nursing homes receive citations, it’s a failure not just of the provider, but of CMS and the survey process as well,” Parkinson said. “Citations and fines without assistance will not help us keep residents and staff safe from this virus.”