By Beth Ann Longo, DrPH, MSN, RN and Stacey Barrett, MA
Previous studies have shown that Joint Commission accredited nursing homes, and other healthcare settings are more likely than non-accredited organizations to make resident safety a top priority, to allocate resources to support this priority, and to be focused on systems and processes that promote optimal quality of care.
But does the same hold true during a widespread pandemic?
Do Joint Commission accredited nursing homes have lower, higher or comparable COVID-19 case rates compared to non-accredited nursing homes?
To investigate this, we compared case rates of Joint Commission accredited and non-accredited nursing homes in Illinois, Florida and Massachusetts – the states with the greatest number of accredited nursing homes. This study is particularly interesting because community case rates are strikingly different in these three states.
The results are detailed in our study, “A Multistate Comparison Study of COVID-19 Cases Among Accredited and Nonaccredited Nursing Homes,” published in Policy, Politics, & Nursing Practice. Per our hypothesis, the single greatest predictor of COVID-19 cases within a nursing care center is the prevalence of COVID-19 in the nursing home’s surrounding community . We found that, on average, Joint Commission accredited and non-accredited nursing homes had comparable COVID-19 case rates. This was likely because the virus was fast moving and widespread across states and communities.
However, while group averages were similar, non-accredited nursing homes had significantly more variability in COVID-19 case rates that spanned from very high to very low rates – a much wider range compared to variation observed in accredited nursing homes. The study revealed that a larger proportion of non-accredited nursing homes had higher than expected COVID-19 case rates (i.e. were negative outliers) as compared to accredited nursing homes.
We know that the pandemic has created significant challenges for nursing homes. In particular, personal protective equipment (PPE) shortages and staffing shortages have put tremendous strain on staff. Health care workers are working like firefighters putting out fires without water since the start of the pandemic. These challenges make nursing homes more susceptible to the spread of COVID-19 to other residents and staff. Yet, despite the challenges caused by the pandemic in communities with high COVID-19 prevalence, Joint Commission accredited nursing homes were less likely to experience extreme COVID-19 case rates (i.e. rates that were highly variable and beyond what was predicted).
As researchers, it is impossible to make specific causal inferences about these differences, but it is reasonable to hypothesize that compliance with Joint Commission standards require accredited nursing homes to devote more attention to:
- infection control
- emergency management
- patient care-related processes
This extra due diligence may have helped accredited nursing homes better manage and control the spread of the virus. Accreditation requirements are designed to help nursing homes:
- reduce variation
- reduce risk
- improve quality
This is the same kind of preparation that helps control the spread of the virus, keep residents safe and support the provision of high quality care while facing unprecedented challenges.
Science is always evolving and this pandemic is no exception . Our research team hopes to continue studying the impact of COVID-19 on the nursing care center community, including a qualitative follow up study to learn more about nursing homes' most significant challenges and how they have been overcome during the pandemic. If you are willing to share ways that your nursing home has effectively addressed COVID-related challenges, we’d love to hear from you! You can reach out to the research team by email at .
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Beth Ann Longo, DrPH, MSN, MBA, RN is an Associate Director in the Department of Research, Division of Healthcare Quality Evaluation at The Joint Commission. Dr. Longo has managed a number of complex federally-funded projects and has directed a range of research projects such as systematically assessing program effectiveness, outcomes of a specific intervention, or the impact of a product, program or service on an organization or its stakeholders. Dr. Longo is very knowledgeable of health care quality and safety measurement in nursing homes at a local, state and national level. Previously, Dr. Longo worked in the Department of Standards and Survey Methods at The Joint Commission and led the development of the Nursing Care Center Post-Acute Care Certification and Memory Care Certification products and was a surveyor for the Nursing Care Center Accreditation Program. Prior to joining The Joint Commission, Dr. Longo held several leadership positions in post-acute care settings during her more than 30 years in healthcare, including prior leadership experience as a nursing home administrator.
Stacey C. Barrett, MA is a Research Scientist in the Department of Research, Division of Health Quality Evaluation at the Joint Commission. Ms. Barrett has over 25 years of expertise managing complex health services research studies involving a variety of topics including infection control, health information technology, electronic clinical quality measures, vaccination practices, patient safety and quality improvement initiatives. Prior to her position at The Joint Commission, Ms. Barrett held several positions in research management at the University of Illinois. She holds a Bachelor’s Degree from Washington University in St. Louis and a Master’s Degree in Research and Social Policy Administration from the University of Chicago.