TY  - JOUR
AU  - Cronin, Christopher J
AU  - Evans, William N
TI  - Nursing Home Quality, COVID-19 Deaths, and Excess Mortality
JF  - National Bureau of Economic Research Working Paper Series
VL  - No. 28012
PY  - 2020
Y2  - October 2020
DO  - 10.3386/w28012
UR  - http://www.nber.org/papers/w28012
L1  - http://www.nber.org/papers/w28012.pdf
N1  - Author contact info:
Christopher J. Cronin
University of Notre Dame
3060 Jenkins Nanovic Halls
Notre Dame, IN 46556
Tel: 5746310427
E-Mail: ccronin1@nd.edu

William N. Evans
Keough-Hesburgh Professor of Economics
Department of Economics
University of Notre Dame
3111 Jenkins Nanovic Halls
Notre Dame, IN 46556-7000
E-Mail: wevans1@nd.edu
M3  - presented at "COVID-19 and Health Outcomes", December 4, 2020
AB  - 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 inspection ratings, have substantially lower COVID-19 mortality.  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, a result consistent with high excess non-COVID mortality among the elderly since March.  The positive correlation between establishment quality and non-COVID mortality is driven entirely by nursing homes located in counties with below-median COVID-19 case rates. As a result, high-quality homes in these counties have significantly more total deaths than their low-quality counterparts.  The concentration of excess death in low-risk areas suggests that future suffering could be avoided with more nuanced guidelines, such as those recently suggested by CMS that outline a role for in-person visits in lower-risk areas.
ER  -