paramedics providing first aid to older man injured in accident

There were more preventable cases and deaths when older adults who were treated at hospitals for COVID-19 were transferred to skilled nursing facilities (SNFs) accepting positive patients compared to facilities not taking people who were infected. This was especially true in SNFs where personal protective equipment (PPE) was in short supply, according to a report published Monday in JAMA Internal Medicine

Researchers looked at a group of 264 skilled nursing facilities that accepted COVID-19–positive patients and 518 facilities that did not allow them. Data came from June 2020 to March 2021.

Over a 15-week follow-up period, the exposed facilities had a cumulative increase of 6.94 additional COVID-19 cases per 100 residents compared with facilities that didn’t let positive patients in. Exposed facilities experienced 2.31 additional cumulative COVID-19–related deaths per 100 residents compared with facilities that did not allow COVID-positive individuals. 

Exposed facilities with staff and PPE shortages had larger increases in COVID-19 cases, the data showed.

“This pattern of outcomes suggests that during the pre-vaccine phase of the pandemic, post-acute care provided to patients who were discharged from a hospital while still requiring transmission-based precautions due to COVID-19 could have served as a vector for early outbreaks in SNFs,” the authors wrote. “COVID-19 outbreaks may have been preventable by better equipping SNFs to accept patients with COVID-19 or by providing post-acute care to patients with COVID-19 outside of the traditional nursing home system, such as in field hospitals or quarantined COVID-19 units.”

The authors noted that it was understandable to promptly discharge stabilized patients from hospitals, but discharging people to nursing facilities without staffing and resource supports may have helped hospitals “at a particularly high cost.”

Investments in staffing, PPE or perhaps creating isolated COVID-19 units in facilities accepting COVID-positive patients may have reduced the risk for the infection to spread or people to die from it, the authors said. Policymakers could have looked into short-term settings for those recovering from COVID, such as temporary field hospitals,  that didn’t include putting them into nursing homes, the authors wrote.