Read on Twitter
Beware of this claim:
«A US resident in a Long-Term Care Facility (LTCF) has a median length of stay (LOS) of 5 months until death, so if they die of COVID-19 it's no big deal»
It's false.
1/n
«A US resident in a Long-Term Care Facility (LTCF) has a median length of stay (LOS) of 5 months until death, so if they die of COVID-19 it's no big deal»
It's false.
1/n
First the definition of LTCF varies by state, but usually is "nursing facilities, assisted living facilities, adult care centers, intermediate care facilities, and/or other long-term care facilities", see https://www.kff.org/health-costs/issue-brief/state-data-and-policy-actions-to-address-coronavirus/#long-term-care-cases-deaths (in Notes under Additional State-level Data)
2/n
2/n
The claim of a 5-month median LOS comes from this 2010 study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945440/
There are 3 flaws with this claim:
Flaw #1: this study only covers nursing facilities, and excludes all other LTCF such as assisted living facilities, adult care centers, etc
3/n
There are 3 flaws with this claim:
Flaw #1: this study only covers nursing facilities, and excludes all other LTCF such as assisted living facilities, adult care centers, etc
3/n
Flaw #2: this study only examines the last admission (until death) in a nursing home. That's why the "at the end of life" terminology is repeated in many places.
4/n
4/n
In other words a resident may be admitted into a nursing home, stay for a while, return home, and years later is re-admitted, until his death.
Only the second stay ("at the end of life") would be included in the statistics of this study.
5/n
Only the second stay ("at the end of life") would be included in the statistics of this study.
5/n
Flaw #3: the median is 5 months, but the mean is 13.7 months (see table 2). If the goal is to quantify the amount of life (persons × years) potentially lost to COVID-19, the mean is what we should be looking at, not the median.
6/n
6/n
More accurate studies on the mean LOS in nursing homes (not necessarily the LOS "at the end of life") show it is around 27 months (eg. https://www.longtermcarelink.net/eldercare/nursing_home.htm claims 835 days)
7/n
7/n
Another study found that on all LTCF (not only nursing homes), the mean LOS was 28.3 months ( https://web.archive.org/web/20190406214411/https://www.ahcancal.org/ncal/facts/Documents/09%202009%20Overview%20of%20Assisted%20Living%20FINAL.pdf)
8/n
8/n
And the end of the stay does not necessarily conclude with death: only 33.1% of discharges are due to death, see table 6.15.
9/n
9/n
So only 1 in 3 LTCF residents die after a mean stay of around 27-28 months.
This implies the average life expectancy of an LTCF resident, at the time of admission in the facility, is greater than 27-28 months.
10/n
This implies the average life expectancy of an LTCF resident, at the time of admission in the facility, is greater than 27-28 months.
10/n
