The impact of COVID-19 hospitalizations on nursing home admissions: a regional insight into long-term care and public health

Background: To obtain the rate of admission to nursing homes (NHs) and to evaluate clinical characteristics and mortality rates of patients admitted to NHs after hospitalizations for COVID-19, compared to non-COVID-19 acutely hospitalized patients. Methods: We analyzed administrative data from Lombardy, a Northen Italian region, in individuals aged ≥50 years who were hospitalized and discharged alive in 2018 for acute conditions or, between February 2020 and June 2022, for COVID-19. Outcomes included NH institutionalization rates within 180 post-discharge day and mortality following NH admission. Kaplan–Meier curves and Cox proportional hazard models adjusted for age, sex, and comorbidities were used to assess the risks. Results: Among 133,216 COVID-19 hospitalizations in 2020–2022 and 239,099 acute hospitalizations in 2018, institutionalization rates within 180 post-discharge days were similar (3.7% for both cohorts). However, COVID-19 patients had higher adjusted risks of institutionalization (HR 1.70; 95% CI 1.63–1.78) and mortality within 6 months after NH admission (HR 2.08; 95% CI 1.90–2.27). Differences were more pronounced when considering patients hospitalized during the first COVID-19 pandemic wave. Conclusion: COVID-19 hospitalization significantly increases the risks of admission to NHs and early mortality after institutionalization in older individuals compared to hospitalizations due to other acute conditions.