military members/ strike team unload PPE at a nursing homes
Nation Guard members and, later, strike teams helped get nursing homes through the pandemic’s first wave. But much remains unclear about their performance. Credit: Boston Globe/Contributor/Getty Images

Nursing home strike teams were a highly touted COVID-19 intervention, but lingering questions about their efficacy point to changes that could improve future emergency responses, a new study finds.

Mortality within Massachusetts nursing homes that received support from one such model appears to have started trending downward even prior to the start of additional resources and medical staff. Based on available information about the facility and the intervention, however, researchers were unable to determine what would have happened with that downward trend without the presence of a strike team, lead author Natalia Festa, MD, a  clinical fellow at Yale University told McKnight’s Wednesday.

As COVID deaths mounted in nursing homes in the pandemic’s first wave, Massachusetts adopted a Nursing Facility Accountability and Support Package (NFASP). The 9-week intervention program gave different levels of assistance to facilities, depending on need. The American Rescue Plan Act awarded $500 million to create similar programs across the country.

“The NFASP was an important pilot intervention, which could serve as a model for future targeted public health interventions within nursing homes,” Festa said. “However, there were too many unknowns regarding time-trends in mortality, nursing home occupancy, and resident characteristics to draw causal inferences regarding the effects of the intervention.”

In the Massachusttes program, the highest level of help went to facilities with a higher share of residents over 65. That could have meant that improvements seen among buildings getting less help were fueled in part by their younger patients being less prone to COVID-related mortality.

Other “confounding factors” also could have been in play, said Festa, whose paper in the Journal of the American Geriatrics Society was co-authored by seven health policy experts from Yale, Harvard and the National Bureau of Economic Research. But because the response teams were established in emergency conditions, few embedded critical data reporting requirements that could have helped researchers better understand what worked to reduce mortality — and possibly, what didn’t.

“We suggest that future strike team interventions capture real-time mortality and resident characteristics that are meaningful predictors of mortality, such as age, comorbidities, and cognitive and functional status,” the researchers wrote. “This information could both enhance program evaluation (by enabling researchers to capture time-varying confounders) and inform risk stratification.

Although they want more intensive data collection, the authors noted that the responsibility shouldn’t fall on overtaxed nursing home staff. Instead, they suggested similar programs use a third-party service to prevent detracting from patient care responsibilities in an emergency.