Widespread reports of severe staffing shortages being felt across the entire long-term care industry has been a key issue for providers during the ongoing public health crisis.

But the shortages have likely been driven by an increased burden on nursing home staffers and not a decline in hours being worked at facilities, according to a new study published in Health Affairs

 “It suggests that this measure we typically use about nursing home staffing levels of [staff] hours per resident day obviously needs to be adjusted for the amount of work that people are doing,” lead researcher Rachel M. Werner told McKnight’s Long-Term Care News on Monday.  

The study found that nurse staff hours per resident day — which takes into account changes in nursing home census — increased slightly between January and September 2020 — from 3.4 hours per resident day in January to 3.5 hours in September. The change translated into an increase of about 5.7 minutes per resident day and a relative increase of 2.8%, according to the study. 

Findings also showed that employed nursing home staff increased from 3.3 hours per resident day to 3.4 hours, for a relative increase of 1%, during the same time period. Contract nursing home staff saw their average increase from 0.11 hours to 0.14 hours per resident day. 

“These findings raise concerns that although the number of staff hours in nursing homes did not decline, the perception of shortages has been driven by increased stresses and demands on staff time due to the pandemic, which are harder to quantify,” Werner and co-author Norma B. Coe wrote. 

Finding showed that nurse staff hours per resident day — which accounted for changes in nursing home census — increased slightly between Jan. and Sept. 2020 — from 3.4 hours per resident day in January to 3.5 hours in September.

Werner, a professor at the University of Pennsylvania, said the quantity of hours work may not reflect the true work environment nursing home staff have experienced during the crisis. 

“It is very likely that the workload of staff actually increased during the pandemic so an hour worked before the pandemic was not the same thing as an hour worked during the pandemic,” she explained. 

‘Felt like a shortage’

She also noted the increase is due to a variety of factors such as limits on visitation, residents being more spread out and no social activities. 

“Even if there wasn’t a true shortage of staff in the sense that the number of hours being worked went down, the amount of work that staff had to do went up, so it felt like a shortage,” Werner said. 

She stressed the importance of having family members being able to visit residents, even during public health emergencies, to help take some of the caregiving burden off staff members. 

She also suggested that nursing home operators consider increasing pay and staffing levels — and not merely maintain them — during emergencies in order to be “more sensitive to the amount of work that we’re asking [staff members] to do.” 

“The main takeaway is that we need to address the staffing problems at nursing homes and we need to treat staff with the respect and importance that they have long deserved within nursing homes,” Werner said. “They really do the lion’s share of the work of keeping vulnerable, older adults safe in the nursing homes.” 

The full findings were published Monday in the May issue of Health Affairs.