The Association of North Dakota Skilled Nursing Facility Characteristics with COVID-19 Outbreak Severity

Context: COVID-19 exerted severe challenges on skilled nursing facility (SNF) residents and staff. A combination of internal and external factors predisposed SNFs to an increased propensity of COVID-19 spread.

Objective: The purpose of this paper is to examine which facility characteristics may have contributed to COVID-19 outbreaks within urban and rural North Dakota skilled nursing facilities.

Methods: A 23-question survey regarding facility characteristics was developed and distributed to all 78 North Dakota skilled nursing facilities (SNF).

Findings: Of the North Dakota SNF, 40 out of 78 total facilities (51.2%) participated in the survey. Of those participating, 38 of 40 (95%) were in counties with populations under 50,000, with the smallest county population being 1,876. A Spearman’s rank test suggested a relationship between the community spread of COVID-19 and the COVID-19 positivity of SNF residents. Spearman’s rank also suggested a positive association between the SNF resident COVID-19 positivity in relation to staff positivity (p-value 0.042) and county rates (p-value 0.045).

Limitations: While this is a comprehensive survey with a very good response rate, two key limitations are identified. First, the survey relies on self-reported data from SNF staff. Second, it is not clear what data would have been received from non-responding SNFs.

Implications: Substantial lessons have been learned, which may not only aid future pandemic preparedness but improve the quality of care for nursing home residents during a pandemic or other respiratory disease outbreaks. Proactively knowing susceptibilities and vulnerabilities ahead of time will allow local and state leaders to plan and allocate resources. Future state and local pandemic emergency plans need to be reviewed with the prioritization of skilled nursing facilities as front line facilities during a pandemic, rather than placing their “traditional” emphasis of emergency preparedness on hospitals.