Staffing Patterns in US Nursing Homes During COVID-19 Outbreaks
Name
shen_2022_oi_220040_1657913533.69407.pdf
Description
Published version
Size
1.02 MB
Format
Adobe PDF
Checksum (MD5)
e92a52d46ef72a9ef7a92f115f32285b
Author(s)
Shen, Karen
McGarry, Brian E
Grabowski, David C
Gruber, Jonathan
Gandhi, Ashvin D
Date Issued
July 2022
Journal
JAMA Health Forum
Publisher
American Medical Association (AMA)
Citation
Shen, Karen, McGarry, Brian E, Grabowski, David C, Gruber, Jonathan and Gandhi, Ashvin D. 2022. "Staffing Patterns in US Nursing Homes During COVID-19 Outbreaks." JAMA Health Forum, 3 (7).
Version
Final published version
Abstract
Importance: Staff absences and departures at nursing homes may put residents at risk and present operational challenges. Objective: To quantify changes in nursing home facility staffing during and after a severe COVID-19 outbreak. Design Setting and Participants: In this cohort study, daily staffing payroll data were used to construct weekly measures of facility staffing, absences, departures, and use of overtime and contract staff among US nursing homes experiencing a severe COVID-19 outbreak that started between June 14, 2020, and January 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. Exposures: Weeks since the beginning of a severe COVID-19 outbreak (4 weeks prior to 16 weeks after). Main Outcomes and Measures: Total weekly staffing hours, staff counts, staff absences, departures, new hires, overtime and contract staff hours measured for all nursing staff and separately by staff type (registered nurses, licensed practical nurses, certified nursing assistants), facility self-reported staff shortages, and resident deaths. Results: Of the included 2967 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. Conclusions and Relevance: In this cohort study of nursing homes experiencing severe COVID-19 outbreaks, facilities experienced considerable staffing challenges during and after outbreaks. These results suggest the need for policy action to ensure facilities' abilities to maintain adequate staffing levels during and after infectious disease outbreaks.
MIT Department
Massachusetts Institute of Technology. Department of Economics
Terms of Use
Creative Commons Attribution 4.0 International license
Persistent DSpace Link
DOI of Published Version
10.1001/jamahealthforum.2022.2151
