A study using Medicare data finds that long-term nursing home stays and deaths after hospitalization for sepsis climbed during the COVID-19 pandemic but that patients of all races and ethnicities experienced these outcomes at similar rates.
A team led by researchers at the University of Rochester and Columbia University analyzed rates of long-term nursing home residence and death among 1,468,754 US community-dwelling patients aged 65 years and older after 2,964,517 hospitalizations for sepsis from January 2016 to June 2021.
The results were published late last week in JAMA Network Open.
Long-term care and aging population
The researchers said they chose sepsis because it is one of the leading causes of death in the United States, leads to high levels of postacute care, is linked to permanent worsening of cognitive function, and disproportionately affects people of minority races.
The average patient age was 76 years, 49.5% were women, 71.2% were White, 9.5% were Black, 9.4% were Hispanic, 3.2% were Asian or Pacific Islander, and 0.7% were American Indian or Alaska Native (AI/AN).
Long-term care services are provided within the framework of a racially and socioeconomically segregated care system.
The researchers noted that the number of Americans aged 65 and older is expected to rise 40% by 2050, and the number aged 85 and older will likely balloon 170%, with older minority adults making up larger proportions, leading to questions of whether the country's long-term care infrastructure can adapt.
"Issues related to inconsistent and sometimes substandard care, insufficient staffing, high staff turnover, and the lack of patient-directed care all contribute to concerns about reliance on this sector for a growing elderly population," they wrote. "Furthermore, long-term care services are provided within the framework of a racially and socioeconomically segregated care system."
Less nursing home care, death prepandemic
Black patients were more likely than their White peers to have long-term nursing home stays or die (adjusted odds ratio [aOR], 1.33), while Asian or Pacific Islander (aOR, 0.79), Hispanic (aOR, 0.72), and AI/AN (aOR, 0.79) patients were less likely.
The renewed focus on nursing homes during the pandemic presents an opportunity to strengthen nursing homes, which serve as the safety net for the most at-risk older individuals.
Long-term nursing home stays or deaths fell from 13.5% in the first quarter of 2016 to 6.9% in the same period of 2020. After adjustment, long-term nursing home stays or deaths declined each quarter (aOR, 0.958) before the COVID-19 pandemic.
Risks of long-term nursing home stays or deaths increased during the pandemic over time (aOR each quarter, 1.03) compared with pre-pandemic for White patients. The pandemic was not tied to differential changes in long-term nursing home stays or deaths for minoritized patients compared with their White counterparts.
"In this cross-sectional study, older adults hospitalized with sepsis experienced an approximately 50% reduction in long-term NH [nursing home] stay or death over a 5-year period before the pandemic," the study authors wrote. "These results suggest that during the pandemic, all individuals, regardless of race and ethnicity, experienced increased long-term NH stay or death compared with before the pandemic."
"The renewed focus on nursing homes during the pandemic presents an opportunity to strengthen nursing homes, which serve as the safety net for the most at-risk older individuals," they concluded.
