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Published on: November 10, 2023
COVID-19 Pandemic in Assisted Living Communities: Results from Seven States
Helena Temkin-Greener1, Wenhan Guo1, Yunjiao Mao1
1Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
Objective:
To describe variations in COVID-19 confirmed cases and deaths among assisted living (AL) residents and examine their associations with key AL characteristics.
Design:
Observational study employing data on confirmed COVID-19 cases and deaths in ALs from seven states, through May 29, 2020.
Setting:
Information on COVID-19 cases/deaths in ALs was obtained from state government websites. A national inventory of ALs was used to identify communities with and without COVID-19 cases/deaths. Medicare Beneficiary Summary File identifying AL residents was employed to develop AL characteristics. County-level COVID-19 laboratory-confirmed cases/deaths were obtained from publicly available data.
Participants:
We found 4,865 ALs (2,647 COVID-19 cases and 777 deaths) in the seven states. After excluding missing data, the sample consisted of 3,994 ALs (82.1%) with 2,542 cases (96.0%) and 675 deaths (86.9%).
Main Outcomes And Measures:
Outcomes were AL-level counts of cases and deaths. Covariates were AL characteristics and county-level confirmed COVID-19 cases/deaths. Multivariable two-part models determined the associations of independent variables with the likelihood of at least one case and death in the AL, and with the count of cases (deaths).
Results:
State case fatality ranged from 3.32% in North Carolina to 9.26% in Connecticut, but for ALs in these states it was 12.89% and 31.59%, respectively. Among ALs with at least one case, midsize communities had fewer cases (incidence rate ratio (IRR) = 0.829; P = .004) than small ALs. ALs with higher proportions of racial/ethnic minorities had more COVID-19 cases (IRR = 1.08; P < .001), as did communities with higher proportions of residents with dementia, chronic obstructive pulmonary disease, and obesity.
Conclusions And Relevance:
ALs with a higher proportion of minorities had more COVID-19 cases. Many of the previously identified individual risk factors are also present in this vulnerable population. The impact of COVID-19 on ALs is as critical as that on nursing homes, and is worth equal attention from policy makers.
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