Characteristics of Skilled Nursing Facilities Associated with Resident COVID-19 Cumulative Incidence Rate in Georgia, USA: May 31, 2020 – January 31, 2021 Open Access

Ashton, Cameron (Spring 2021)

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The ongoing Coronavirus Disease 2019 (COVID-19) pandemic has a disproportionate burden of cases and deaths among the residents and staff of skilled nursing facilities (SNFs). Evaluating facility outbreaks can inform effective public health policy and COVID-19 mitigation protocols to protect the vulnerable populations within SNFs.


This study aimed to determine characteristics of SNFs that are associated with resident COVID-19 cumulative incidence rate during the second and third Waves of the epidemic in the state of Georgia.


We compiled publicly available data from the Centers for Medicare and Medicaid Services (CMS) regarding SNF characteristics and COVID-19 outcomes between May 31, 2020 and January 31, 2021. Then, regression analyses were used to examine the associations between nursing home characteristics and COVID-19 cumulative incidence among facility residents.


This study found meaningful associations between multiple facility-level characteristics and laboratory-confirmed COVID-19 cases amongst residents of SNFs in the state of Georgia between May 31, 2020 and January 31, 2021. These effects often varied between Waves Two and Three of the epidemic. In both Waves, larger numbers of staff cases and shortages of staff classified as “other” were associated with larger resident case rates, while increased daily staff hours per resident were generally associated with decreased resident case rates. Facilities with higher CMS 5-star ratings had smaller resident case rates in Wave Two but larger resident case rates in Wave Three. Similarly, facilities located in hospitals had smaller resident case rates in Wave Two and larger resident case rates in Wave Three. Finally, facilities in nonmetro-urban and nonmetro-rural areas, compared to metro-urban areas, had smaller resident case rates in Wave Two but larger resident case rates in Wave Three. Limitations in the data and unmeasured confounding may impact the findings of this study.

Table of Contents

Table of Contents

Distribution Agreement - i

Approval Sheet - ii

Abstract Cover Sheet - iii

Abstract - iv

Relevance - iv

Objective - iv

Design - iv

Findings - iv

Thesis Cover Page - v

Acknowledgements - vi

Table of Contents - vii

Introduction - 1

Background - 1

Objective - 3

Methods - 4

Study Sample and Data Sources - 4

Statistical Analysis - 5

Results - 6

Descriptive - 6

Bivariable Analysis - 7

Multivariable Analysis - 9

Discussion - 12

Key Findings - 12

Interpretations and Implications - 13

Limitations - 15

Recommendations - 17

Conclusions - 17

Figures and Tables - 19

Figure 1 - 19

Table 1 - 20

Table 2 - 21

Table 3 - 22

Table 4 - 23

References - 24

Supplementary Materials - 26

Figure S1 - 26

Figure S2 - 27

Figure S3 - 28

Table S1 - 29

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