Nursing home policymakers should direct greater interventions to inner city and rural facilities while providers cultivate local school relationships, according to a new policy brief from LeadingAge.  

Analysis of socioeconomic data overlaid with the locations of 12,600 nursing homes shows that 16% of facilities are in neighborhoods considered to be in severely disadvantaged areas. 

Residents were more likely to be Black and Medicaid recipients. Staffing levels at those facilities are 30% lower for registered nurses and 38% lower for physical and occupational therapists than in areas that are not considered disadvantaged. Nursing homes in these areas also are most likely to be owned by for-profit entities, the policy brief from the association of nonprofit providers explained. 

The brief — “Neighborhood Deprivation and Nursing Home Staffing: Lessons and Policy and Practice” — recommends that policymakers geographically micro-target increased Medicare and Medicaid reimbursements to facilities with the greatest staffing inequalities. 

“There are no easy solutions,” said Robyn I. Stone, DrPH, the co-director for the LeadingAge LTSS Center at the University of Massachusetts Boston. 

Operators in these areas can take some practical steps as well. The report suggests creating clinical placements with local nursing schools and creating career paths for certified nursing assistants to become RNs. The paper also recommends that facilities work with local high schools to recruit students as CNAs.

“The providers need to think local in terms of pipelines and career advancement,” Stone said.  

The data indicates a concerning trend that facilities in these disadvantaged neighborhoods are using CNAs for care that is traditionally provided by RNs, the report noted. The report noted that staff turnover in these areas tends to be high, particularly among RNs, and recruiting and retention is particularly difficult for a number of reasons, including perceptions of having to do more administrative work and lower pay due to a greater reliance on Medicaid reimbursements.

Prospective employees also face challenges commuting to nursing homes in disadvantaged neighborhoods, which the report said could be tackled through ride-sharing models or working with policymakers to enhance public transportation. The report also suggests creating a National Service Corps for RNs in which people would commit to “several years’ employment” in exchange for extra pay and other benefits.