Thread by @zorinaq

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

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 kff.org/health-costs/i… (in Notes under Additional State-level Data)

2/n

The claim of a 5-month median LOS comes from this 2010 study: ncbi.nlm.nih.gov/pmc/articles/P…

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

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

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

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. longtermcarelink.net/eldercare/nurs… claims 835 days)

7/n

Another study found that on all LTCF (not only nursing homes), the mean LOS was 28.3 months (web.archive.org/web/2019040621…)

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

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