BriggsNetNews

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

Examination of Staffing Shortages at US Nursing Homes During the COVID-19 Pandemic was published in JAMA Network Open on July 27, 2023.  You’ll find the link to open this publication as a PDF (easier to read) on this landing page.

Key Points

Question: Do nursing home administrator perspectives on staffing in US nursing homes during the COVID-19 pandemic provide context for conflicting staffing data reports?

Findings: In this study, qualitative and quantitative data from 40 US nursing homes were integrated to assess staffing levels during the pandemic. Short-term compensatory strategies were used by administrators to comply with minimum staffing regulations and offset staffing shortages.

Meaning: Findings from this study suggest that staffing shortages during the COVID-19 pandemic placed strain on nursing homes.

A total of 156 interviews were completed with 40 nursing home administrators. Administrators reported experiencing staff shortages during the COVID-19 pandemic and using compensatory strategies, such as overtime, cross-training, staff-to-resident ratio adjustments, use of agency staff, and curtailing admissions, to maintain operations and comply with minimum staffing regulations. Payroll Based Journal data measures graphed from January 1, 2020, to September 30, 2022, supported administrator reports showing that study facilities had reductions in staff hours, increased use of agency staff, and decreased resident census. Findings were similar to national trends.

The COVID-19 pandemic has put tremendous strain on the US nursing home workforce. Burnout, low wages, poor work conditions, and the increased burden of caring for vulnerable residents during a health crisis have contributed to a 13.3% decrease in nursing home sector employment since the start of the pandemic. Nursing homes currently employ 1.37 million workers (roughly 10% below projected demand) and continue to face staff shortages. Administrators have responded to ongoing staff shortages by increasing staff workloads, halting or decreasing new admissions, and offering substantial wage raises and other incentives to retain staff. Despite these efforts, only 2% of all nursing homes in the US reported being fully staffed in 2022. Although staff shortages at nursing homes have been widely reported, quantitative studies have found mixed evidence of staffing shortfalls. One study found no decrease in staffing levels during the early part of the pandemic after accounting for a decreased census. The Kaiser Family Foundation reported that nursing home staffing shortages coincided with COVID-19 variant surges, varied widely by state, and peaked in January 2022 at 34%. In contrast, an analysis that used detailed employee-level payroll data found staffing patterns consistent with reports of nursing homes experiencing major staffing challenges during severe COVID-19 outbreaks and for extended periods of time after the outbreak. This study conducted a qualitative assessment of nursing home administrator experiences during the pandemic and integrated qualitative findings with quantitative analysis of national payroll staffing data. The objective was to provide context to conflicting aggregated data on nursing home staffing levels during the COVID-19 pandemic.

The above are just 3 of the graphs/tables provided in this interesting report. 

Findings from this qualitative mixed-methods study may have implications for future research and policy. The dual approach of quantitative and qualitative analyses provides depth and context to our understanding of complex topics such as staffing and nursing home care. It remains unclear how long the crisis adaptation techniques nursing home administrators used can persist without major effects on staff and resident safety. More mixed-methods research is needed to better understand the long term outcomes of the COVID-19 pandemic associated with nursing home staffing and how policies and regulations around staffing during a crisis, such as a pandemic, have aided or limited the efficacy of administrator responses to maintain quality care for their residents. Policymakers should consider reviewing current nursing home regulations around staffing and work with nursing home administrators to create policies that more nimbly adjust to crisis management.

Please take some time to review, share and discuss this report with your team and colleagues.