Kimberly Marselas

Never has it been so important for skilled nursing providers to know what their employees are doing when they leave the building.

Amid a pandemic, it appears, one of the most dangerous places an employee might go is to another caregiving job. But aside from voluntary screening responses, providers have had little way to track employees with multiple jobs — until now.

The smart folks at the Yale Tobin Center for Economic Policy recently teamed up with US Digital Response to create a free, interactive map that shows just how interconnected the nation’s nursing homes really are.

It’s an engaging, insightful tool that shows not only how many providers are sharing staff — but also hints at how many staff members must be working multiple jobs to make ends meet.

“Our data shows 80% of skilled nursing facilities rely on shared staffing,” said Tobin Center Executive Director Dave Wilkinson. “They’re essential and, of course, these folks are also naturally one potential driver of infection.”

The Tobin Center publicly launched its site on a call with state epidemiologists the week of March 21. It’s also available to skilled nursing providers and anyone else interested in the nation’s tangled staffing web.

Wilkinson, providing a walk through during a call with LeadingAge members last week, said the tool is the “richest and most detailed look ever” at staff sharing. It builds on research from the Yale School of Management that found stopping staff cross-traffic could have led to a 44% decline in nursing home COVID-19 cases.

The research and the mapping tool are fed by anonymous cell phone data overlaid with GPS imaging that indicates when the same phone pings within multiple CMS-regulated skilled nursing facilities. During the early days of nursing home lockdowns, researchers reported 7% of the 500,000-plus phones (each representing a worker) went from building to building.

Mining for connections

The map now allows providers or public health officials to drill down into all that data, searching by a single location, a community or an entire state to see what level of interconnectedness exists.

Diagrams that look a little like the now-iconic CDC COVID-19 illustration show important links.

This screen capture diagrams all recorded staff connections in a single nursing home.

In Pennsylvania, for instance, nearly 80% of 547 facilities with connections to others are in the moderate or high levels. Wanting to see if I could spot check the previous research finding that staff-sharing is a major indicator of outbreaks, I clicked into data for two nearby ManorCare facilities that reported a combined, 200-plus cases of COVID-19 last April. 

Though they are in the “very high” and “high connectivity” ranges, they are surprisingly not connected to each other, according to the data shown.

The data sample is not exhaustive. It includes about 30% of U.S. cell phones, and users can set privacy settings to restrict tracking. But the Tobin Center is now working to add other healthcare and senior care settings to its map to better inform providers about potential COVID-19 spread.

Wilkinson said officials in some states are already using the tool to create early warning systems, an approach that could be especially helpful as “continuous surveillance testing recedes.”

But the ability to spot an potential infection vector before an outbreak of COVID-19, flu or the emerging candida auris threat also give this technology merit long into the future.

Nursing homes could use it to decide whether to institute more monitoring and protective measures, such as increased use of PPE; forge partnerships among employers who share workers; and help target communication to staff networks.

Let’s hope policymakers also take a look. Maybe they’ll see the greater risks of a system that forces employees to work multiple shifts in multiple buildings just to earn a fair living.

Kimberly Marselas is senior editor of McKnight’s Long-Term Care News.