Independent Research Confirms That A Long Term Care Facility’s Location Is A Key Factor In The Likelihood Of A COVID-19 Outbreak

COVID-19 has taken a disproportionate toll on long term care residents despite every effort by their caregivers. David C. Grabowski, professor of health-care policy at Harvard Medical School, R. Tamara Konetzka, professor of health services at the University of Chicago and Vincent Mor, professor of health services policy and practice at Brown University have conducted independent research that shows that the location of a nursing home, asymptomatic spread and availability of testing are determining factors in COVID-19 outbreaks – not quality ratings, infection citations or staffing.

In an op-ed in The Washington Post, Drs. Grabowski, Mor and Konetzka write: 

“[A]ccording to our research, location and facility size matter much more than prior quality in predicting whether a nursing home will have a serious covid-19 outbreak. The most important factors influencing whether and how large an outbreak occurs in a nursing home are the population density of the county in which the facility is located, the prevalence of the virus reported in the county and the racial distribution of the nursing home, which are all correlated.

“Location matters because the coronavirus that causes covid-19 often spreads without causing symptoms. Visitors have not been allowed in most facilities since March, but staff members still go to work. If a covid-19 outbreak is underway in the community where staff members live, the pandemic will soon be in the nursing home where they work.

“Many nursing homes can improve their infection-control procedures. But the expectation that good nursing homes can stop transmission while poorly rated nursing homes cannot is unwarranted. Many top-rated nursing homes have been overwhelmed, while a lot of poorly rated ones are free of covid-19 largely because their staff members live in areas with low rates of infection.”

Washington State’s Life Care Center of Kirkland (LCCK) is a prime example of a nursing home that experienced a widespread outbreak despite providers doing all they could to prevent it. The state filed a complaint against the facility, but a decision by Administrative Law Judge Matt Perkins confirmed that LCCK followed the appropriate public health guidelines.

In an op-ed in Morning Consult, Mark Parkinson, president and CEO of the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) explains why taking legal action was not the appropriate response: 

​“Perkins’ decision proves that officials in the long-term care facility adhered to protocols and did everything in their power to protect residents from the vicious virus. What unfolded in Washington state demonstrates that pursuing legal action and imposing monetary penalties against long-term care providers, particularly in a crisis, is not a remedy to improve the overall quality of care. Instead, these actions oftentimes fail to account for the entirety of what unfolded in a particular facility.”

We all need to work together to ensure the safety of our most vulnerable citizens and the heroic caregivers who watch over them. Containing the spread of the virus among the general population is paramount. As long term care workers come in and out of facilities, they risk exposing themselves to the virus and bringing it into their buildings. Members of the public can do their part to keep seniors and long term care workers safe by wearing a mask, keeping physical distance from others, and practicing proper hygiene.

In addition, nursing homes and assisted living communities must be equipped with the proper tools to prevent outbreaks. This includes adequate personal protective equipment (PPE), testing and staffing. These are baseline resources that many providers still struggle to acquire months into the pandemic and will be further strained as the growing number of cases across the country increase demand for these resources.

Now is the time for reinforced support for long term care. Providers have been able to turn the tide on the virus because of the funding and resources they’ve received, but ongoing support is critical as the pandemic wages on. If we can continue to rally around the long term care sector, we can prevent another spike in cases.

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) represents more than 14,000 non-profit and proprietary skilled nursing centers, assisted living communities, sub-acute centers and homes for individuals with intellectual and development disabilities. By delivering solutions for quality care, AHCA/NCAL aims to improve the lives of the millions of frail, elderly and individuals with disabilities who receive long term or post-acute care in our member facilities each day. For more information, please visit or