One in five nursing home operators remain “severely” short on the staff and personal protective equipment needed to prevent COVID-19 outbreaks in their facilities, an analysis of new federal data has revealed.

There was no meaningful improvement in shortages overall from May to July 2020, reported investigators from the University of Rochester, New York, and Harvard. The facilities that were most likely to report shortages were those that had COVID-19 cases, more Medicaid recipients and lower-quality scores. The data was drawn from the new Centers for Medicare & Medicaid Services’ COVID-19 Nursing Home Database.

Equipment shortages — most often for masks and gowns — were reported nationwide, but there were notable shortage clusters in northern New England, Iowa, Alabama, North Carolina, West Virginia and Tennessee, the investigators wrote. Meanwhile, a quarter of U.S. counties had at least 44% of nursing homes reporting a staff shortage, most commonly of nurses and nursing aides. Clusters of high staff shortages were found in the south and Midwest, especially in Louisiana, Alabama, eastern Texas and Georgia.

Although the federal government in May promised to provide all U.S. nursing homes with two weeks’ worth of PPE, many reported that they did not receive adequate equipment through this initiative, the researchers wrote. What’s more, the ongoing struggle to recruit and retain staff prior to the pandemic has been magnified due to fears of transmission and illness, they added.

“Given the disproportionate burden of morbidity and mortality faced by nursing home residents, the magnitude of these shortfalls poses a major threat to public health,” wrote Brian E. McGarry, Ph.D., of the University of Rochester. This is especially true in areas with the highest proportions of severely under-equipped nursing homes, he added. In fact, many of these operations experienced infection surges in July and August.

“Policies aimed at providing resources to obtain additional direct care staff and PPE to these vulnerable nursing homes, particularly in areas with rising community COVID-19 case rates, are needed to reduce the national COVID-19 death toll,” the authors wrote.

“Unless these shortages are prioritized by policymakers, long-term care residents will continue to be at a great disadvantage in the pandemic,” they concluded.

The analysis includes some of the first results from federal data gleaned from the CDC’s National Healthcare Safety Network COVID-19 Long Term Care Facility Module, the researchers said. Facility information was obtained through the Certification and Survey Provider Enhancement Reports system via the federally funded LTCFocus.org website, and the 2020 Nursing Home Compare Provider Information file.

In context: Read McKnight’s Executive Editor James M. Berklan’s take on the new report here.