Featured in HMS PULSE: Research by Grabowski and Colleagues Examines the Lasting Effects of the Pandemic on U.S. Nursing Homes 

Examining the future of nursing home care

Research and therapeutics

As COVID-19 spread alarmingly across the world in 2020, it was particularly ruthless inside nursing homes. Filled with older residents—some with advanced health issues—living closely together and occupied by caregivers moving from room to room, these homes became ground zero for the virus that causes COVID-19.

While it’s clear that COVID-19 devastated these homes in the short term, the pandemic’s lasting impact on them is unclear. David Grabowski, PhD, a professor of health care policy in the Blavatnik Institute at Harvard Medical School, and his peers at Brown University are examining the long-term impact of the pandemic on occupancy, staffing, patient mix, ethnic and racial disparities, and quality of care in U.S. nursing homes. Their work is being supported by a $1.48 million grant from The Warren Alpert Foundation.

“Although there is growing consensus that policy reform is needed, the nursing home sector today is decidedly different from the nursing home sector in 2019,” says Grabowski. “Relative to pre-pandemic, fewer individuals want to live or work at a nursing home. How should we think about reforming nursing home policy in the context of this shift?”

Nurse clasping hand of elderly woman

The Harvard-Brown project team has worked together for over a decade on issues related to post-acute and long-term care, each school bringing expertise in particular areas. In fact, the study team received a $1.2 million Warren Alpert Foundation grant in 2019 to evaluate a Medicare nursing home payment change that occurred that year.

For the current project, the team will use a mixed methods research design (i.e., a research approach combining quantitative and qualitative methods in a single study) to examine how the pandemic has changed nursing homes. For its quantitative work, the team will study, among other things, the impact of the pandemic on nursing home admission decisions, occupancy, case mix, payer mix, length of stay, and facility closures and sales. For its qualitative work, the team will interview discharge planners, nursing home administrators, medical directors, families, and residents about how the pandemic has changed nursing homes.

“This research is important,” Grabowski says, “because subsequent pandemics are likely, nursing homes will always be a vulnerable setting, and the public health and medical communities will need to understand how lasting changes in nursing homes will impact residents and their caregivers going forward.”

Relative to pre-pandemic, fewer individuals want to live or work at a nursing home. How should we think about reforming nursing home policy in the context of this shift?

David Grabowski

Robert H. Brown Jr., DPhil, MD ’75, who is a member of The Warren Alpert Foundation’s board of directors and the chair of its grants committee, as well as a professor of neurology at UMass Chan Medical School, says that this joint project contributes to the missions of HMS, The Warren Alpert Medical School of Brown University, and the Foundation.

“One of the primary goals of The Warren Alpert Foundation is to support institutions engaged in the advancement of human knowledge for the benefit of human health,” Brown says. “Harvard and Brown are both committed to promoting research and scholarship to ensure equitable, efficient public health and enhance outcomes for those facing heightened risks due to ineffective and inefficient care.”

The Department of Health Care Policy at HMS is dedicated to promoting research and teaching programs focused on critical health care policy issues.

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