For-profit nursing homes had less severe COVID lockdowns, lower death rates

For-profit nursing homes have generally imposed less severe lockdown measures during the COVID-19 pandemic than their non-profit and public counterparts.

It could have saved a life.

A working paper released Wednesday by the Mercatus Center at George Mason University shows that visits to for-profit nursing homes fell less sharply and recovered more quickly than other facilities with different governance structures. Victor Melo, the paper’s author, argues that profit motives likely drove for-profit nursing home managers to make decisions that better balanced the needs of staff and residents.

“Restrictive isolation measures are a trade-off for residents,” Melo writes. “These measures benefit residents by reducing their chances of getting sick and dying from COVID-19. But they impose great costs on residents by preventing them from being with their families and friends, which negatively affects their mental health and potentially hastens death from other causes.”

By comparison, he writes, nonprofit and government agencies may have been more likely to prioritize the interests of staff, for whom intense lockdowns were less costly because they could leave at the end of their shift, go home and see their loved ones. alone.

Nursing homes were in many ways the flashpoint of the COVID-19 pandemic because of the vulnerability of residents and the degree of control that staff and management could exercise. Many of the worst outbreaks in the early stages of the pandemic occurred in nursing homes, and more than one third of all COVID-related deaths in the United States in the first year of the pandemic occurred in nursing homes and other long-term care facilities.

So protecting residents from COVID was an important task for nursing home managers, but Mello’s article argues that extended periods of isolation came with other potentially deadlier trade-offs. Melo’s statistical model shows that between June 2020 and March 2022, nonprofit nursing homes had fewer deaths from COVID, but the overall death rate was higher than for-profit nursing homes over the same period.

“If nonprofit nursing homes were to implement stricter isolation measures, such policies would likely lead to higher rates of depression and mental illness, and the rate of decline in the health of residents with brain conditions such as dementia,” he writes. . “Thus, nursing homes with more restrictive isolation measures are expected to have more non-Covid-related deaths, even after these measures end.”

“The increase in non-COVID-19 deaths caused by the more restrictive isolation measures,” Melo concludes, “overwhelmed the reduction in COVID-19 deaths associated with those measures.”

Because their residents were essentially paying customers, for-profit nursing homes had to consider how their policies would deter or attract future customers. Nonprofits and government agencies could have more easily given up on these issues, sparing the financial woes of prolonged lockdowns, but possibly leading to worse outcomes for their residents in the long run.

Mehl’s paper suggests that patients in general will be better served if health care providers are driven by profit-driven decision-making, even in the absence of a pandemic.

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