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Nursing home staff networks and COVID-19

Author

Listed:
  • M. Keith Chen

    (Anderson School of Management, University of California, Los Angeles, CA 90095)

  • Judith A. Chevalier

    (Yale School of Management, Yale University, New Haven, CT 06511; National Bureau of Economic Research, Cambridge, MA 02138)

  • Elisa F. Long

    (Anderson School of Management, University of California, Los Angeles, CA 90095)

Abstract

Nursing homes and other long-term care facilities account for a disproportionate share of COVID-19 cases and fatalities worldwide. Outbreaks in US nursing homes have persisted despite nationwide visitor restrictions beginning in mid-March. An early report issued by the Centers for Disease Control and Prevention identified staff members working in multiple nursing homes as a likely source of spread from the Life Care Center in Kirkland, WA, to other skilled nursing facilities. The full extent of staff connections between nursing homes—and the role these connections serve in spreading a highly contagious respiratory infection—is currently unknown given the lack of centralized data on cross-facility employment. We perform a large-scale analysis of nursing home connections via shared staff and contractors using device-level geolocation data from 50 million smartphones, and find that 5.1% of smartphone users who visited a nursing home for at least 1 h also visited another facility during our 11-wk study period—even after visitor restrictions were imposed. We construct network measures of connectedness and estimate that nursing homes, on average, share connections with 7.1 other facilities. Traditional federal regulatory metrics of nursing home quality are unimportant in predicting outbreaks, consistent with recent research. Controlling for demographic and other factors, a home’s staff network connections and its centrality within the greater network strongly predict COVID-19 cases.

Suggested Citation

  • M. Keith Chen & Judith A. Chevalier & Elisa F. Long, 2021. "Nursing home staff networks and COVID-19," Proceedings of the National Academy of Sciences, Proceedings of the National Academy of Sciences, vol. 118(1), pages 2015455118-, January.
    • Handle: RePEc:nas:journl:v:118:y:2021:p:e2015455118
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    Cited by:

    1. Klopack, Ben & Luco, Fernando, 2025. "JUE Insight: Measuring local consumption with payment cards and cell phone pings," Journal of Urban Economics, Elsevier, vol. 149(C).
    2. Sourafel Girma & David Paton, 2024. "Covid-19 Vaccines As a Condition of Employment: Impact on Uptake, Staffing, and Mortality in Elderly Care Homes," Management Science, INFORMS, vol. 70(5), pages 2882-2899, May.
    3. Drost, Alyssa & Alam, M Injamam & Boamah, Sheila & Kralj, Boris & Costa, Andrew & Sweetman, Arthur, 2023. "Multiple jobholding and part-time work among nurses in long-term care homes compared to other healthcare sectors: Evidence from Ontario," Health Policy, Elsevier, vol. 130(C).
    4. Coven, Joshua & Gupta, Arpit & Yao, Iris, 2023. "JUE Insight: Urban flight seeded the COVID-19 pandemic across the United States," Journal of Urban Economics, Elsevier, vol. 133(C).
    5. Antoci, Angelo & Sabatini, Fabio & Sacco, Pier Luigi & Sodini, Mauro, 2022. "Experts vs. policymakers in the COVID-19 policy response," Journal of Economic Behavior & Organization, Elsevier, vol. 201(C), pages 22-39.
    6. Matthew Spiegel & Heather Tookes, 2021. "Business Restrictions and COVID-19 Fatalities [The immediate effect of COVID-19 policies on social distancing behavior in the United States]," The Review of Financial Studies, Society for Financial Studies, vol. 34(11), pages 5266-5308.
    7. Xavier Flawinne & Mathieu Lefebvre & Sergio Perelman & Pierre Pestieau & Jérôme Schoenmaeckers, 2023. "Nursing homes and mortality in Europe: Uncertain causality," Health Economics, John Wiley & Sons, Ltd., vol. 32(1), pages 134-154, January.
    8. Christopher Avery & William Bossert & Adam Clark & Glenn Ellison & Sara Fisher Ellison, 2020. "An Economist's Guide to Epidemiology Models of Infectious Disease," Journal of Economic Perspectives, American Economic Association, vol. 34(4), pages 79-104, Fall.
    9. Roland Pongou & Guy Tchuente & Jean-Baptiste Tondji, 2021. "Optimally Targeting Interventions in Networks during a Pandemic: Theory and Evidence from the Networks of Nursing Homes in the United States," Papers 2110.10230, arXiv.org.
    10. Zheng, Wenxin & Shi, Wenfeng & Fan, Tianlong & Lü, Linyuan, 2025. "Weighted cycle-based identification of influential node groups in complex networks," Physica A: Statistical Mechanics and its Applications, Elsevier, vol. 677(C).
    11. Cronin, Christopher J. & Evans, William N., 2022. "Nursing home quality, COVID-19 deaths, and excess mortality," Journal of Health Economics, Elsevier, vol. 82(C).
    12. Pongou, Roland & Sidie, Ghislain Junior & Tchuente, Guy & Tondji, Jean-Baptiste, 2022. "Profits, Pandemics, and Lockdown Effectiveness in Nursing Home Networks," National Institute of Economic and Social Research (NIESR) Discussion Papers 540, National Institute of Economic and Social Research.
    13. Abe Dunn & Joshua D Gottlieb & Adam Hale Shapiro & Daniel J Sonnenstuhl & Pietro Tebaldi, 2024. "A Denial a Day Keeps the Doctor Away," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 139(1), pages 187-233.
    14. Casey B. Mulligan, 2021. "The Backward Art of Slowing the Spread? Congregation Efficiencies during COVID-19," NBER Working Papers 28737, National Bureau of Economic Research, Inc.
    15. Nathan M. Stall & Kevin A. Brown & Antonina Maltsev & Aaron Jones & Andrew P. Costa & Vanessa Allen & Adalsteinn D. Brown & Gerald A. Evans & David N. Fisman & Jennie Johnstone & Peter Jüni & Kamil Ma, 2021. "COVID‐19 and Ontario's Long‐Term Care Homes," Journal of Elder Policy, John Wiley & Sons, vol. 1(3), pages 65-110, September.
    16. Girma, Sourafel & Paton, David, 2024. "Using double-debiased machine learning to estimate the impact of Covid-19 vaccination on mortality and staff absences in elderly care homes," European Economic Review, Elsevier, vol. 170(C).
    17. Gallo, Edoardo & Barak, Darija & Langtry, Alastair, 2023. "Social distancing in networks: A web-based interactive experiment," Journal of Behavioral and Experimental Economics (formerly The Journal of Socio-Economics), Elsevier, vol. 107(C).
    18. Paul L. Joskow, 2022. "From Scarcity to Abundance: Government and Private Initiatives to Manage the Allocation of N95 Masks in the U.S. During the COVID-19 Pandemic," NBER Working Papers 29876, National Bureau of Economic Research, Inc.
    19. Theresa Kuchler & Johannes Stroebel, 2022. "Social Interactions, Resilience, and Access to Economic Opportunity: A Research Agenda for the Field of Computational Social Science," CESifo Working Paper Series 9606, CESifo.
    20. Almagro, Milena & Coven, Joshua & Gupta, Arpit & Orane-Hutchinson, Angelo, 2023. "Disparities in COVID-19 risk exposure: Evidence from geolocation data," Regional Science and Urban Economics, Elsevier, vol. 102(C).
    21. Pongou, Roland & Tchuente, Guy & Tondji, Jean-Baptiste, 2021. "Optimally Targeting Interventions in Networks during a Pandemic: Theory and Evidence from the Networks of Nursing Homes in the United States," GLO Discussion Paper Series 957, Global Labor Organization (GLO).
    22. A. James O'Malley & Thomas A. Bubolz & Jonathan S. Skinner, 2021. "The Diffusion of Health Care Fraud: A Network Analysis," NBER Working Papers 28560, National Bureau of Economic Research, Inc.
    23. Taylor A Begley & Daniel Weagley, 2023. "Firm Finances and the Spread of COVID-19: Evidence from Nursing Homes," The Review of Corporate Finance Studies, Society for Financial Studies, vol. 12(1), pages 1-35.
    24. Vincent W. Slaugh & Alan A. Scheller-Wolf, 2023. "Flexibility and Consistency in Long-Term Care Rostering," Manufacturing & Service Operations Management, INFORMS, vol. 25(2), pages 719-736, March.
    25. Eric Budish, 2020. "Maximize Utility subject to R≤1: A Simple Price-Theory Approach to Covid-19 Lockdown and Reopening Policy," NBER Working Papers 28093, National Bureau of Economic Research, Inc.

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    Keywords

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    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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