In this study by Shen, et al. (2022) of nearly 3,000 nursing homes in 2020, there were significant declines in staffing levels during a severe COVID-19 outbreak that remained significantly reduced 16 weeks after the outbreak’s start. Facilities temporarily increased hiring, contract staff and overtime to bolster staffing during outbreaks, but these measures did not fully replace lost staff, particularly certified nursing assistants.

Daily staffing payroll data were used to construct weekly measures of facility staffing, absences, departures, and use of overtime and contract staff among U.S. nursing homes experiencing a severe COVID-19 outbreak that started between June 14, 2020, and Jan. 1, 2021. Facility outbreaks were identified using COVID-19 case data. An event-study design with facility and week fixed effects was used to investigate the association of severe outbreaks with staffing measures.

Of the included 2,967 nursing homes experiencing severe COVID-19 outbreaks, severe outbreaks were associated with a statistically significant drop in nursing staffing levels owing to elevated absences and departures. Four weeks after an outbreak’s start, around when average new cases peaked, staffing hours were 2.6% (95% CI, 2.1%-3.2%) of the mean below preoutbreak levels, despite facilities taking substantial measures to bolster staffing through increased hiring and the use of contract staff and overtime. Because these measures were mostly temporary, staffing declined further in later weeks; 16 weeks after an outbreak’s start, staffing hours were 5.5% (95% CI, 4.5%-6.5%) of the mean below preoutbreak levels. Staffing declines were greatest among certified nursing assistants, primarily owing to smaller increases in new hires of this staff type compared with licensed practical nurses and registered nurses.

The researchers say their findings suggest the need for policy action to ensure facilities’ abilities to maintain adequate staffing levels during and after infectious disease outbreaks.

Reference: Shen K, et al. Staffing Patterns in US Nursing Homes During COVID-19 Outbreaks. JAMA Health Forum. 2022;3(7):e222151. doi:10.1001/jamahealthforum.2022.2151

Source: JAMA Health Forum