Five-star nursing homes have lower death rates from Covid-19 but higher death rates from other causes, apparently because some patients who are isolated for their own good are dying from loneliness, says a study by two economists from the University of Notre Dame.
“These homes exposed their residents to severe isolation in an attempt to prevent infection, subsequently leading to premature death by other causes,” says the study, a National Bureau of Economic Research working paper (PDF) by Christopher J. Cronin and William N. Evans.
In parts of the country where the rate of Covid-19 infection in the community is low, five-star nursing homes “have significantly more deaths than their low-quality counterparts,” the study says.
“No way around it—these numbers are incredibly sad,” Cronin says in a video presentation of the paper on the NBER website.
The excess deaths from causes other than Covid-19 are concentrated in places where the rate of infection in the community is low. It’s possible that in places where the community infection rate is high, “the most fragile patients” die of Covid-19 before loneliness and despair can take them away, the authors write.
One hopeful sign for lonely, isolated nursing home residents is that in September the Centers for Medicare & Medicaid Services changed their guidance to permit more visitors. In fact, if a facility has had no COVID-19 cases in the last two weeks and the local infection rate isn’t high, a nursing home “must” facilitate visits, the government says. Its memo (PDF) is blunt:
While CMS guidance has focused on protecting nursing home residents from COVID-19, we recognize that physical separation from family and other loved ones has taken a physical and emotional toll on residents. Residents may feel socially isolated, leading to increased risk for depression, anxiety, and other expressions of distress. Residents living with cognitive impairment or other disabilities may find visitor restrictions and other ongoing changes related to COVID-19 confusing or upsetting. CMS understands that nursing home residents derive value from the physical, emotional, and spiritual support they receive through visitation from family and friends.
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