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Nursing home quality, COVID-19 deaths, and excess mortality

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  • Cronin, Christopher J.
  • Evans, William N.

Abstract

The COVID-19 pandemic in the US has been particularly devastating for nursing home residents. A key question is how have some nursing homes been able to effectively protect their residents, while others have not? Using data on the universe of US nursing homes, we examine whether establishment quality is predictive of COVID-19 mortality. Higher-quality nursing homes, as measured by CMS overall five-star rating, have substantially lower COVID-19 mortality through September of 2020. Quality does not predict the ability to prevent any COVID-19 resident or staff cases, but higher-quality establishments prevent the spread of resident infections conditional on having one. Preventing COVID-19 cases and deaths may come at some cost, as high-quality homes have substantially higher non-COVID deaths. The positive correlation between establishment quality and non-COVID mortality is strong enough that high-quality homes also have more total deaths than their low-quality counterparts and this relationship has grown with time. As of late April 2021, five-star homes have experienced 8.4 percent more total deaths than one-star homes.

Suggested Citation

  • Cronin, Christopher J. & Evans, William N., 2022. "Nursing home quality, COVID-19 deaths, and excess mortality," Journal of Health Economics, Elsevier, vol. 82(C).
    • Handle: RePEc:eee:jhecon:v:82:y:2022:i:c:s0167629622000121
    DOI: 10.1016/j.jhealeco.2022.102592
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    Cited by:

    1. Pensieroso, Luca & Sommacal, Alessandro & Spolverini, Gaia, 2023. "Intergenerational coresidence and the Covid-19 pandemic in the United States," Economics & Human Biology, Elsevier, vol. 49(C).
    2. Xavier Flawinne & Mathieu Lefebvre & Sergio Perelman & Pierre Pestieau & Jérôme Schoenmaeckers, 2023. "Nursing homes and mortality in Europe: Uncertain causality," Health Economics, John Wiley & Sons, Ltd., vol. 32(1), pages 134-154, January.
    3. Heather Kolakowski & Mardelle McCuskey Shepley & Ellie Valenzuela-Mendoza & Nicolas R. Ziebarth, 2021. "How the COVID-19 Pandemic Will Change Workplaces, Healthcare Markets and Healthy Living: An Overview and Assessment," Sustainability, MDPI, vol. 13(18), pages 1-19, September.
    4. Janiak, Alexandre & Machado, Caio & Turén, Javier, 2021. "Covid-19 contagion, economic activity and business reopening protocols," Journal of Economic Behavior & Organization, Elsevier, vol. 182(C), pages 264-284.
    5. Michael Alexeev & Ivan Dedyukhin & Leonid Polishchuk, 2024. "Ownership, Asymmetric Information, and Quality of Care for the Elderly: Evidence from US Nursing Homes During the COVID-19 Pandemic," CAEPR Working Papers 2024-006 Classification-, Center for Applied Economics and Policy Research, Department of Economics, Indiana University Bloomington.
    6. Melo, Vitor, 2022. "Intended and Unintended Effects of Nursing Home Isolation Measures," Working Papers 12244, George Mason University, Mercatus Center.
    7. Samuel Cole & Duha T. Altindag, 2023. "Managerial turnover in primary care clinics," Economic Inquiry, Western Economic Association International, vol. 61(4), pages 942-964, October.
    8. Caterina Alacevich & Nicolò Cavalli & Osea Giuntella & Raffaele Lagravinese & Francesco Moscone & Catia Nicodemo, 2021. "The presence of care homes and excess deaths during the COVID‐19 pandemic: Evidence from Italy," Health Economics, John Wiley & Sons, Ltd., vol. 30(7), pages 1703-1710, July.

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    More about this item

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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