Self-reported nurse staffing shortages in United States nursing homes during the height of the pandemic were linked to less care per resident and a 10.5% increase in resident deaths, a new study has found.
“The results suggest that addressing staffing shortages in nursing homes can save lives,” wrote author Sushant Joshi, PhD, of the University of Southern California Sol Price School of Public Policy.
“Policies aimed at improving access and quality of care in nursing homes, especially in times of major health crises such as the COVID-19 pandemic, must consider ways to increase staffing, either through interventions aimed at retaining the existing staff or by attracting additional staff,” he added.
For the period between May 31, 2020, and May 15, 2022, Joshi used payroll data to measure staffing hours per resident, and measured weekly resident deaths and staffing shortages using data from the Centers for Disease Control and Prevention’s National Healthcare Safety Network.
Among the more than 15,000 nursing homes represented, between 18% and 33% reported staffing shortages during any given week. These shortages were directly related to lower staffing hours per resident, including a 1.8% decline in registered nurse hours, a 1.7% decrease in licensed practical nurse hours and a 2.4% decline in certified nursing assistant hours.
These labor shortfalls appeared to have a significant impact on resident outcomes as well, Joshi found. Staffing shortages during any week were positively associated with a 10.5% increase in total resident deaths, or 0.068 total deaths per 100 residents. They were also associated with increases in resident deaths from COVID-19 and non-COVID-19 causes individually.
Nursing homes lost more than 220,000 workers since the start of the pandemic, according to the Bureau of Labor Statistics, and most have not yet come back. The Centers for Medicare & Medicaid Services also reports 166,000 residents have died of COVID-19 through April of this year.
Staffing levels remain depressed across the nation. To improve safety and comply with regulations, many providers are limiting operations.
Notably, the decrease in staffing hours found in Joshi’s study was concentrated in employee hours rather than contract hours. There was also a slight increase in contract hours associated with staffing shortages, Joshi reported. The study methodology did not determine whether staffing hours declined due to staff absences or departures.
Self-reporting may result in incomplete data, but staffing shortages in the study were consistent with daily staffing hours reported elsewhere, Joshi wrote. There is also the possibility that cause of death was more likely to be misclassified during the pandemic (COVID-19 versus non-COVID-19), but mortality increases were seen in both cases, so this may not necessarily have limited the study findings, he added.
The findings were published in JAMDA.
