Minnesota’s care homes are a COVID-19 disaster area. How can we improve that?

At the latest count, 78% of Minnesota’s 1,504 Covid-19 deaths have come in our state’s care homes. This is the fourth highest share in the United States: indeed, Minnesota has had more deaths in its care homes – 1,172 – than 30 states have had in total. Minnesota’s Covid-19 crisis is first and foremost a crisis in its care homes.

I have often pointed this out and been asked ‘Well, what would you do?’, a not unreasonable question. New research offers an answer.

In a new paper titled ‘Nursing Home Staff Networks and COVID-19‘, researchers M. Keith ChenJudith A. Chevalier, and Elisa F. Long note that:

An early report issued by the Centers for Disease Control and Prevention identified staff members working in multiple nursing homes as a likely source of spread from the Life Care Center in Kirkland, Washington to other skilled nursing facilities.


The full extent of staff connections between nursing homes—and the crucial role these connections serve in spreading a highly contagious respiratory infection—is currently unknown given the lack of centralized data on cross-facility nursing home employment.

Chen, Chevalier, and Long:

…perform the first large-scale analysis of nursing home connections via shared staff using device-level geolocation data from 30 million smartphones, and find that 7 percent of smartphones appearing in a nursing home also appeared in at least one other facility—even after visitor restrictions were imposed. 


…estimate that nursing homes have, on average, connections with 15 other facilities.

These linkages, it appears, are an important avenue of Covid-19 transmission. Chen, Chevalier, and Long conclude that: 

Controlling for demographic and other factors, a home’s staff-network connections and its centrality within the greater network strongly predict COVID-19 cases. Traditional federal regulatory metrics of nursing home quality are unimportant in predicting outbreaks, consistent with recent research. Results suggest that eliminating staff linkages between nursing homes could reduce COVID-19 infections in nursing homes by 44 percent.

That is a huge number: 44% of 1,172 is 516 people. If Minnesota is to get on top of its Covid-19 crisis, reducing transmission between care homes by reducing shared staff seems to be an important part of the strategy.

John Phelan is an economist at the Center of the American Experiment.