• Lewis A Lipsitz, Alida M Lujan, Alyssa Dufour, Gary Abrahams, Helen Magliozzi, Laurie Herndon, and Mohammad Dar.
• Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
• J Am Geriatr Soc. 2020 Nov 1; 68 (11): 2447-2453.

Background/ObjectivesIn April 2020, Massachusetts nursing homes (NHs) became a hotspot for COVID-19 infections and associated deaths. In response, Governor Charles Baker allocated $130 million in additional funding for 2 months contingent on compliance with a new set of care criteria including mandatory testing of all residents and staff, and a 28-point infection control checklist. We aimed to describe the Massachusetts effort and associated outcomes.DesignLongitudinal cohort study.SettingA total of 360 Massachusetts NHs.ParticipantsThe Massachusetts Senior Care Association and Hebrew SeniorLife rapidly organized a Central Command team, targeted 123 "special focus" facilities with infection control deficiencies for on-site and virtual consultations, and offered all 360 facilities weekly webinars and answers to questions regarding infection control procedures. The facilities were also informed of resources for the acquisition of personal protective equipment (PPE), backup staff, and SARS-CoV-2 testing.MeasurementsWe used two data sources: (1) four state audits of all NHs, and (2) weekly NH reports to the Massachusetts Center for Health Information and Analysis. Primary independent process measures were the checklist scores and adherence to each of its six core competencies. Primary outcomes were the average weekly rates of new infections, hospitalizations, and deaths in residents and staff. We used a hurdle mixed effects model adjusted for county COVID-19 prevalence to estimate relationships between infection control process measures and rates of new infections or deaths.ResultsBoth resident and staff infection rates started higher in special focus facilities, then rapidly declined to the same low level in both groups. Adherence to infection control processes, especially proper wearing of PPE and cohorting, was significantly associated with declines in weekly infection and mortality rates.ConclusionThis statewide effort could serve as a national model for other states to prevent the devastating effects of pandemics such as COVID-19 in frail NH residents.© 2020 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.

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