The Changing Landscape of AD/ADRD Care at Nursing Homes During the COVID-19 Pandemic

This supplement examines the long-term impact of the COVID-19 pandemic on the characteristics, quality, and racial/ethnic inequities in nursing home care for individuals with Alzheimer Disease or Alzheimer’s Disease-Related Dementia’s (AD/ADRD). Many of the deficiencies in care delivery that existed prior to the pandemic at some facilities – understaffing, lack of a strong clinician presence onsite, overuse of physical and chemical (i.e., antipsychotic medications) restraints, frequent transfers to the hospital, and high rates of falls and pressure ulcers – may have been compounded by the pandemic, as facilities implemented new infection control practices and visitor restrictions, alongside dealing with COVID protections (and infections) among staff, and worsening staff shortages. These impacts were likely particularly acute for nursing home residents with AD/ADRD, who are especially vulnerable and difficult to protect from COVID, since adherence to masking, physical distancing, and isolation protocols is more difficult for those with cognitive and memory deficits. We will first analyze the key aspects of nursing home care affecting health outcomes for residents with AD/ADRD at baseline, prior to the COVID-19 pandemic. Key features of a facility include its staffing levels, composition, and consistency of staff assignment; financial resources and management; facility layout, infrastructure, availability of private rooms, and performance on health inspections and other quality measures. Important health outcomes for AD/ADRD residents include hospitalizations, mortality, cognitive function, mood, and behavioral issues. Second, we will analyze how these same key aspects of nursing home care for residents with ADRD changed during (and after) the COVID-19 pandemic. We will also examine how the pandemic affected pre-existing disparities along racial, ethnic, and socioeconomic dimensions in access to and receipt of high-quality SNF care for individuals with AD/ADRD. In particular, we will examine whether pandemic driven changes in nursing home functioning (e.g., staffing levels, staffing experience, and financial health) have contributed to widening disparities in access and quality. The parent grant, NBER Center for Aging and Health Research, supports new research development on important questions relating to health at older ages. While the parent grant is not focused on Alzheimer's Disease, this supplement would add to a growing collection of Center-supported research activity on long-term care, and health care inequities, particularly among those with cognitive decline.