Long-Term Care Facilities as a Risk Factor for Death Due to Covid-19: Evidence from European Countries and U.S. States

Abstract

Background: A large percentage of the deaths from the first wave of COVID-19 in 2020 occurred among residents of long-term care facilities. Objective: There are two competing explanations for this phenomenon. First, the structural features of such settings may lead to death. Alternatively, individuals living in these facilities are in poorer health than those living elsewhere, and they would have died even if they had not been in these facilities. Methods: Using both European and U.S. data, we empirically examine these competing hypotheses, which have very different public policy implications. We collected data on Covid-19 mortality rates and on the number of long-term care beds, in each of (1) thirty-two European countries and (2) the fifty U.S. states. Results: Controlling for other relevant factors, we find that there is a significant positive association between the number of long-term care beds per capita in a country or state and overall COVID-19 mortality rates in countries and states. Conclusions: This finding provides support for the claim that long-term care living arrangements of older people are a significant risk factor for dying from COVID-19. These findings raise policy implications. Efforts should be geared to protecting older adults living in long-term care settings. Policy makers might even consider alternative dwelling options during an epidemic period, such as encouraging residents to live with their families whenever possible.