Nursing homes with reported COVID-19 cases previously had higher rates of deficiencies and complaints, according to a research letter published Thursday in JAMA.

The study used public data from about 8,900 nursing homes, and about 3,000 of those facilities had reported coronavirus cases as of April 29. 

Nursing homes treating coronavirus patients had more health and emergency preparedness deficiencies, on average, when compared to facilities that weren’t reporting cases. Additionally, the analysis found that facilities with cases, on average, had more reported incidences and substantiated complaints than those that didn’t have any cases. 

“The largest difference between nursing homes with and without COVID-19 cases was observed in county-level rates of COVID-19, suggesting that when the surrounding population case rate is high, area nursing homes are at a high risk of infections,” the authors wrote. 

They also said that operators also have experienced years of declining revenue and financial instability, which could have made nursing homes ill prepared for any type of pandemic. 

Earlier studies have shown that nursing homes that are larger and have more black residents are at an increased chance of having a COVID-19 case. That previous research also found that star ratings, prior infection violations and Medicaid were not significantly related to facilities having a positive coronavirus case.