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. 2023 Nov;24(11):1755-1760.e7.
doi: 10.1016/j.jamda.2023.04.017. Epub 2023 May 29.

Longitudinal Associations of Staff Shortages and Staff Levels with Health Outcomes in Nursing Homes

Ming Chen  1 , James S Goodwin  2 , James E Bailey  1 , John R Bowblis  3 , Shuang Li  4 , Huiwen Xu  5
Affiliations

Longitudinal Associations of Staff Shortages and Staff Levels with Health Outcomes in Nursing Homes

Ming Chen et al. J Am Med Dir Assoc. 2023 Nov.

Abstract

Objectives: To examine whether facility-reported staff shortages and total staff levels were independently associated with changes in nursing home (NH) outcomes in 2020.

Design: Longitudinal cohort study.

Setting and participants: A total of 8466 NHs with staffing and outcome data.

Methods: This study used NH COVID-19 Public File (2020), Nursing Home Compare (2019-2020), and Payroll-Based Journal data (2019-2020). Outcome measures included the percentage of long-stay residents in a facility with declines in activities in daily living (ADLs), decreases in mobility, weight loss, and pressure ulcers in 2020 Q2, 2020 Q3, and 2020 Q4. Independent variables were whether NHs reported any shortage of aides or licensed nurses and total staff hours per resident day (HPRD). Separate 2-level (NH, state) Hierarchical Generalized Linear Mixed models examined the association of facility-reported shortages and staff hours with key NH resident outcomes, controlling for NH characteristics and COVID-19 infections.

Results: The weekly percentage of NHs reporting any staff shortage averaged 20%. Total staff HPRD increased slightly from 3.7 in 2019 to 3.8 in 2020. Health outcomes were stable during 2019 and 2020 Q1 but worsened substantially starting in 2020 Q2. For example, the percentage of residents with mobility loss increased from 16.2% in 2020 Q1 to 27.9% in 2020 Q4. Facility-reported staff shortages were associated with an increase in the proportion of residents with an ADL decline (0.54 percentage points), mobility loss (0.80 percentage points), weight loss (0.22 percentage points), and pressure ulcers (0.22 percentage points) (all P < .01). Total staff HPRD was not associated with changes in any outcomes (all P > .05).

Conclusions and implications: NHs reported worsened health outcomes among long-stay residents in 2020, with worse outcomes found among facilities that reported staff shortages but not among those with lower total staff levels. Facility-reported shortages provide important quality information during the COVID-19 pandemic.

Keywords: COVID-19 pandemic; Staff shortages; health outcomes; staff hours per resident day.

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Conflict of interest statement

Conflict of Interests: JRB provides consulting services to various health care and long-term care stakeholders, including government agencies and providers.

Figures

Figure 1.
Figure 1.. Time trends in facility-reported staff shortages among nursing homes (May 2020 – December 2020).
Weekly facility-reported shortage data for 8,466 nursing homes were obtained from the Nursing Home COVID-19 Public File. Data for the last week of each month are presented. Error bars represent the 95% confidence intervals of the points. Shortage of total staff was defined as any shortage in aides or licensed nurses (registered nurses and licensed practical nurses).
Figure 2.
Figure 2.. Time trends in nursing home health outcomes (2019 Q1 – 2020 Q4).
Outcome data for 8,466 nursing homes were obtained from the Nursing Home Compare data archive. ADLs = Activities of Daily Living. The 95% confidence intervals for the points were all less than 0.6% and are not shown in the figure.
See this image and copyright information in PMC

References

    1. McMichael TM, Currie DW, Clark S, et al. Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington. N Engl J Med 2020;382(21):2005–2011. - PMC - PubMed
    1. Yang BK, Carter MW, Nelson HW. Trends in COVID-19 cases, deaths, and staffing shortages in US nursing homes by rural and urban status. Geriatr Nurs 2021;42(6):1356–1361. - PMC - PubMed
    1. Stephenson J Report Dissects “Devastating Impact” of COVID-19 in Nursing Homes in 2020. JAMA Health Forum 2021;2(6):e212226. - PubMed
    1. Barnett ML, Waken RJ, Zheng J, et al. Changes in Health and Quality of Life in US Skilled Nursing Facilities by COVID-19 Exposure Status in 2020. JAMA 2022;328(10):941–950. - PMC - PubMed
    1. Yourish K, Lai KR, Ivory D, et al. One-third of all US coronavirus deaths are nursing home residents or workers. New York Times 2020.

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