Residents at crowded nursing homes twice as likely to be infected with – and die of -COVID-19

Residents of crowded nursing homes are at higher risk of coronavirus infection and death compared to other elderly people, a new study suggests.

Researchers found senior citizens who lived in highly packed facilities were more than twice as likely to contract COVID-19 and die from the disease.

What’s more, a simulation found that if all four-bed rooms were turned into two-bed rooms, nearly 1,000 cases and 300 deaths could have been prevented.

The team, from the University of Toronto, in Ontario, Canada, says the findings underscore the importance of measures such as reducing capacity in nursing homes and even lodging the elderly in underoccupied hotels until the pandemic can be curbed.

A new study from the University of Toronto found that elderly residents of crowded nursing homes were twice as likely to be infected with and die from COVID-19 than those living in non-crowded homes (above)

A simulation found that turning all four-bed rooms into two-bed rooms could have prevented 1,000 cases and more than 260 deaths among residents. Pictured: Administrator Jackeline Bones talks with Sister Jeane Girardin (right) at St Chretienne Retirement Residence, a home for Catholic nuns in Marlborough, Massachusetts, August 2020

A simulation found that turning all four-bed rooms into two-bed rooms could have prevented 1,000 cases and more than 260 deaths among residents. Pictured: Administrator Jackeline Bones talks with Sister Jeane Girardin (right) at St Chretienne Retirement Residence, a home for Catholic nuns in Marlborough, Massachusetts, August 2020

During the course of the pandemic, estimates have suggested that nursing home residents comprise around 35 percent of COVID-19 deaths in the US and up to 81 percent of deaths in Canada.

Compared with older adults who live in their own houses and apartments, nursing home residents are five times more likely to die of the virus.

However, ‘[i]t is more difficult to understand why COVID-19 may severely affect certain nursing homes but spare others,’ the authors wrote.

For the study, published in JAMA Internal Medicine, the team looked at data from more than 78,600 residents of 618 nursing homes in Ontario, Canada.

As of May 20, 5,218 residents, or 6.6 percent, tested positive for COVID-19 and 1,452 residents, about 1.8 percent, died of the disease.

Across all 618 homes, the index ranged from 1.3, meaning mainly single-occupancy rooms with a private bathroom, to 4.0, which was exclusively rooms that housed four people with a shared bathroom.

Homes that had a high crowding index were more likely to have infections and deaths than homes low on the index.

More than the double the amount of residents in crowded nursing homes were infected at 9.7 percent compared to 4.5 percent.

Additionally, nearly twice as many residents died in crowded facilities with a rate of 2.7 percent in comparison with 1.3 percent in non-crowded homes.    

Results also showed that crowded homes were more likely to be operated by private for-profit owners and had lower staffing ratios.

This is linked to the fact that many for-profit owners were more likely to operate homes with older design standards, such as four-bed rooms, which were eliminated after 1999.

Additionally, researchers conducted a simulation in which all four-bed rooms were converted in two-bed rooms.

They found that doing this could have prevented nearly 1,000 cases of COVID-19 and more than 260 deaths.

In another simulation, all multiple-occupancy rooms were converted to single-occupancy rooms, and the researchers estimated more than 1,600 infections and nearly 440 deaths may have been prevented. 

The team says it hopes the findings can help public health officials and lawmakers develop interventions that target crowded in nursing homes.

‘Such interventions have been used in shelter systems, specifically by reducing capacity and adding new shelter beds in separate locations,’ the authors wrote.   

‘Additional measures, such as retrofitting of underoccupied hotels to act as temporary nursing homes and rapid structural adaptations to homes that are overly crowded, could be considered.’