An analysis of “severe outbreaks” of COVID-19 in nursing homes between January 1, 2017 and June 30, 2021 finds that “the contemporaneous increase in staffing shortages and resident non-COVID-19-related deaths is consistent with worsened resident health owing to inadequate staffing.” The COVID pandemic began in 2020. In other words, nurse staffing shortages during severe outbreaks of the pandemic were correlated with resident deaths from causes other than COVID-19, documenting, once again, the correlation of insufficient nurse staffing levels with poorer resident outcomes.
The study was intended to “quantify the association of severe COVID-19 outbreaks with changes in facility staff,” using payroll-based journal data. Its final sample was 2,967 facilities, a 10% sample of facilities in the highest tier of COVID-19 outbreaks.
During severe COVID-19 outbreaks, facilities lost nursing staff, due to temporary absences and permanent departures from the workforce. Facilities coped with these losses largely by using contract staff and paying overtime to facility staff. However, since facilities’ declining numbers of residents were larger than the reductions in nursing staff, nurse staffing levels were actually higher during severe outbreaks than before the pandemic. Nevertheless, facilities were more likely to report severe nursing shortages during severe outbreaks.
The largest decline in nursing staff was among certified nurse aides, who typically have low wages and limited benefits. As of early May 2022, more than one million nursing home staff members were confirmed to have COVID-19 and more than 2300 of them died. The researchers observe that this death rate means that nursing homes surpass the most deadly occupations in the country, which include commercial fishing and logging.
The researchers call for strike teams to supplement facilities’ nursing staff, as needed, and increasing Medicaid reimbursement, with wage pass-throughs. They question “whether traditional staffing measures accurately capture the adequacy of staffing levels during a pandemic or if new measures are needed.”
- The article: Karen Shen, Brian E. McGarry, David C Grabowski, Jonathan Gruber, Ashvin D. Gandhi, “Staffing Patterns in US Nursing Homes During COVID-19 Outbreaks,” JAMA Health Forum. 2022;3(7):e222151. doi:10.1001/jamahealthforum.2022.2151, PDF of article available at https://jamanetwork.com/journals/jama-health-forum/fullarticle/2794538
July 28, 2022 – T. Edelman