Abstract
Emergency management responses to COVID-19 in nursing homes lacked preparation and nuance; moving forward, responses must recognize nursing homes are not generic organizations or services, and individually appreciate each’s unique nature, strengths and limitations.
Objective:
To describe an approach to stratifying nursing homes according to risk for COVID-19 outbreak.
Methods:
Population-based cross-sectional study of all accredited nursing homes in Victoria (n=766), accommodating 48,824 permanent residents. We examined each home’s facility structure, governance history, socio-economic status, proximity to high-risk industry, and proximity and size of local acute public hospital, stratified by location, size and organizational structure.
Results:
Privately owned nursing homes tend to be larger and metropolitan-based, and publicly owned homes regionally based and smaller in size. The details reveal additional nuance, e.g. privately owned metropolitan-based medium-to-large-sized facilities tended to have more regulatory non-compliance, no board of governance, and fewer Chief Executive Officers with clinical background. In contrast, the smaller, publicly owned, remote facilities perform better on those same metrics.
Conclusion:
Nursing homes should not be regarded as generic entities, and there is significant underlying heterogeneity. Stratification of nursing homes according to risk level is a viable approach to informing more nuanced policy direction and resource allocation for emergency management responses.