Doctor of Philosophy, Miami University, 2024, Gerontology

The COVID-19 pandemic has exposed vulnerabilities within the healthcare system, with nursing homes in under-resourced communities particularly impacted. Numerous studies have linked community socioeconomic status to both care quality and COVID-19 outcomes in these settings, suggesting that nursing homes in disadvantaged neighborhoods provide lower quality care, resulting in poorer health outcomes for residents. However, whether high-quality nursing homes can effectively reduce these health disparities remains unclear. Additionally, conventional long-term care research often overlooks spatial relationships, which can introduce bias into findings. Understanding these dynamics is essential for building resilience against future health emergencies. This study explores the relationships among neighborhood disadvantage, care quality, and COVID-19 outcomes in Ohio nursing homes, examining the potential influence of spatial relationships. While nursing homes in more disadvantaged areas generally exhibit lower quality performance, these quality metrics do not show significant associations with neighborhood socioeconomic status after adjusting for organizational factors and resident characteristics. Instead, quality performance is associated with factors like financial health (e.g., Medicaid payor mix, occupancy rates), stable in-house staffing, consistent leadership, and resident demographics. The study also reveals consistently high mortality risks among residents in nursing homes located in disadvantaged neighborhoods, which are unaffected by quality performance indicators. While COVID-19 incidence rates among residents and staff show no significant associations with neighborhood socioeconomic status, higher CMS Five-Star Staffing ratings and resident satisfaction scores significantly reduce resident COVID-19 incidence rates over the two-year pandemic period. Conversely, higher CMS Five-Star Overall, Health Inspection, and Staffing ratings are linked to increased sta (open full item for complete abstract)

Committee: J. Scott Brown (Committee Chair); Robert Applebaum (Committee Member); Jing Zhang (Committee Member); Saruna Ghimire (Committee Member); Suzanne Kunkel (Committee Member) Subjects: Gerontology