Even in skilled nursing facilities (SNFs) without active Covid-19 outbreaks, the pandemic exacted a toll on residents in the form of increased weight loss and depressive symptoms.
These facts likely will not come as a surprise to SNF operators who have observed changes in their residents, but there is now data confirming these trends, thanks to findings from researchers with Harvard, Brigham and Womens Hospital, and Washington University in St. Louis.
Although a growing literature has documented the effect of Covid-19 on nursing homes, less evidence exists on health outcomes among LTC residents who did not contract Covid-19 but nevertheless endured stress and isolation during the pandemic, the authors wrote in a JAMA article published online on Monday. Understanding the effects of pandemic-related policy change is critical to define the trade-offs involved when facing future pandemic waves.
Policy changes related to Covid-19 included closing buildings to visitors, ending communal dining and other social gatherings, and disruptions in certain types of care, including outpatient, hospital and surgical care.
Noting widespread speculation that such changes led to adverse effects for SNF residents as the pandemic dragged on, the researchers examined Medicare and Minimum Data Set 3.0 data for more than 15,000 facilities. They compared pre-pandemic data from 2018 and 2019 with pandemic data from 2020.
Among the key findings:
So, weight loss and depressive symptoms significantly increased in SNFs during the first year of the pandemic, regardless of the presence of Covid-19 in a building in a given month, the researchers wrote.
Weight loss can worsen frailty and sarcopenia, which are risk factors for increased mortality among this resident population, they noted.
However, mortality rates only worsened in SNFs with Covid-19 outbreaks, while mortality rates slightly declined in SNFs without Covid-19 outbreaks.
Tighter infection control policies might have played a role in this decrease in mortality, along with residents moving around less frequently and therefore sustaining fewer falls, the researchers postulated.
But the decrease in mortality also occurred amid a substantial decline in hospitalizations and emergency department visits by SNF patients.
The observed changes during the pandemic suggest that some hospital use in SNFs has little mortality benefit, the authors wrote. This is relevant for initiatives to reduce excessive hospitalization in SNFs, which have been a major focus of nursing home quality-improvement efforts for years.
The studys limitations included the focus on Medicare fee-for-service data, which covers only a portion of long-stay residents. So, the authors cautioned that the findings might not be generalizable to all SNF residents.
