Nontraditional Small House Nursing Homes Have Fewer COVID-19 Cases and Deaths.
Sheryl Zimmerman, Carol Dumond-Stryker, Meera Tandan and 4 others
PMID 33516670WHAT IT FOUND
Green House and small nursing homes had lower COVID-19 case, admission, and death rates than nearby traditional homes.
The gap was largest among the highest-rate homes, but ownership and resident mix may explain part of it.
Key findings
01Green House/small nursing homes had significantly lower rates of COVID-19 cases, admissions/readmissions, and mortality than matched traditional nursing homes, including at the 75th and 90th percentiles.
02The median case rate was 0 per 1000 resident days in Green House/small nursing homes and traditional homes with fewer than 50 beds, but 0.06 per 1000 resident days in traditional homes with 50 or more beds.
03For deaths among positive cases, the median mortality rate was 0 per 100 positive cases in Green House/small nursing homes, 10 in traditional homes with fewer than 50 beds, and 12.5 in traditional homes with 50 or more beds.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study compared nursing home organizations, not individual residents, so it cannot prove that the Green House model caused lower infection rates in any one person. Green House and traditional homes differed in for-profit status, resident case-mix, and other features that were not measured or adjusted in the analysis. Data came from reported counts and Centers for Medicare and Medicaid Services records, and the paper states that the accuracy of those data cannot be affirmed. The analysis covered only January 20, 2020 through July 31, 2020, and some homes were changing their models of care around that time. Rates were very low overall, so the paper focused on medians and percentiles rather than averages. Matching used nearby homes within 100 miles, not random assignment, so unmeasured local differences may remain.
Declared interests
No funding or conflict-of-interest declaration is included in the article text. The background section notes that Green House homes have been widely researched, largely with funding from The Robert Wood Johnson Foundation.
The easy way to misread this
Do not read these results as proof that moving residents into Green House homes will lower their individual COVID-19 risk. The study compared facilities with different ownership, resident mix, and other unmeasured features, and it could not separate the effect of any single component.