A research letter published today in JAMA Network Open suggests that US states and territories that had more policies aimed at reducing COVID-19 rates in nursing homes (NHs) and home healthcare agencies (HHAs) didn't necessarily have a lower burden of the disease.
The Columbia University–led research team used NH- and/or HHA-specific policies from state and territory government websites to identify 38 COVID-19 policies implemented from March 2020 to July 2022. They then linked the policy data with community-level and NH-specific COVID-19 cases and deaths to create a dataset and dashboard to help researchers and public health officials assess policy effectiveness.
"The COVID-19 pandemic disproportionately affected older persons, many of whom were served by home health care agencies (HHAs) and nursing homes (NHs)," the researchers wrote. "The extent to which state- and territory-level COVID-19 policies reinforced or expanded federal policies is unknown."
Fewer policies on HHAs than NHs
In total, 1,400 policies were identified in 50 states and 5 territories. Most (60.4%) included all health care settings, followed by NH-specific (34.7%), NH- and HHA-specific (3.1%), and HHA-specific (1.8%) policies.
The policies were aimed at preventing SARS-CoV-2 transmission (52.6%), expanding NH and/or HHA capacity (23.2%), easing administrative requirements (13.1%), reporting COVID-19 data (5.6%), and admitting and releasing patients (3.9%).
Future public health planning and pandemic responses should include adaptive and targeted policy interventions and should consider specific needs of all health care settings.
Having more state- and territory COVID-19 policies wasn't consistently tied to lower community- or NH-level disease burden, which the authors said suggests that policy effectiveness may depend on implementation and compliance.
"For example, on May 24, 2020, Montana, Hawaii, and Alaska had no COVID-19 deaths or policies, in contrast with North Carolina's moderate burden and several policies," the researchers wrote. "By January 12, 2021, New York had a severe COVID-19 burden and the greatest number of policies, while Pennsylvania, Montana, and Florida had a similar COVID-19 burden but fewer policies."
Less attention was paid to HHAs than NHs, even though both settings served high-risk older people. "This suggests a gap in public health planning, raising questions about resource allocation and prioritization among health care settings during pandemics," they wrote.
The researchers' dataset and dashboard provide a way to visualize efforts to mitigate public health crises, they said.
"Future public health planning and pandemic responses should include adaptive and targeted policy interventions and should consider specific needs of all health care settings," they concluded. "Dashboards have the potential to help formulate data-driven decision-making during public health crises."
