No Connection Between Nursing Home Ratings, Profit Status and COVID-19 — But Race a Major Factor

Differences in nursing homes’ federal quality ratings and profit status have no bearing on the probability of COVID-19 infections, a University of Chicago researcher said during testimony before the U.S. Senate on Thursday — but preliminary data does indicate a strong connection between race and coronavirus outbreaks.

“Nursing homes are often a reflection of the neighborhoods in which they are located,” R. Tamara Konetzka, a professor at UChicago’s Department of Public Health Sciences, said during a hearing held by the Senate Special Committee on Aging. “Consistent with the pandemic generally, nursing homes with traditionally underserved, non-white populations are bearing the worst outcomes.”

That means that the socioeconomic factors that often break along racial lines have exerted significant influence on the patterns of COVID-19 infections in nursing homes.


“We found a strong and consistent relationship between race and the probability of COVID-19 cases and deaths,” Konetzka said. “Nursing homes with the lowest percent [of] white residents were more than twice as likely to have cases or deaths as those with the highest percent [of] white residents.”

Source: Senate Committee on Aging, Tamara Konetzka

That said, Konetzka found no connection between COVID-19 infections and a nursing home’s five-star rating on Nursing Home Compare, the federal government’s scorecard for facility quality, or its ownership by a for-profit or non-profit organization; there was only a weak correlation between the percentage of Medicaid-covered residents and COVID cases, she said.

Source: Senate Committee on Aging, Tamara Konetzka

“We conclude from this analysis that while some nursing homes undoubtedly had better infection control practices than others, the enormity of this pandemic, coupled with the inherent vulnerability of the nursing home setting, left even the highest-quality nursing homes largely unprepared,” Konetzka said.


The professor’s recommendations for short-term solutions included many efforts requested by both the industry and officials, including staffing support and increased access to testing and personal protective equipment (PPE).

Konetzka also called for greater funding for in-home services, as families grapple with the decision to place a family member in institutional care at a high-risk time, as well as transparent data on case numbers in nursing homes to help further inform consumer decisions.

But in the longer term, Konetzka argued for a complete overhaul of the way that nursing homes receive payment for their services, noting that strict rules around infection control and other safety measures — while necessary — can only go so far to fix a profoundly broken system.

One positive outcome of the COVID-19 crisis of 2020, she said, would be that the situation would force lawmakers to consider “a fundamental reevaluation” of payment mechanisms for long-term care.

“The effectiveness of regulation is limited when the structure of nursing home payment is fragmented, uneven, and leads to systematic underfunding of essential services,” Konetzka said. “Those of us who study long-term care are accustomed to hoping for fundamental change and not seeing it.”