Nursing home administrators stressed about their industry’s sustainability due to the costs of responding to COVID-19, lost revenue, and the negative portrayal of nursing homes by the media, found a study released online Monday.

Conducting 156 interviews with administrators in 2020 and 2021, researchers from Brown and Harvard universities found they faced challenges in implementing government policies and expressed a need for additional support and resources. The interviewees represented 40 nursing homes in eight US markets, and many expressed a desire for more collaborative relationships with policymakers and a place at the table in decision-making.

“While media portrayals of SNFs throughout COVID-19 presented SNFs in a largely negative light, as a place few would choose to reside, we found administrators and other SNF staff to be fully committed to bringing SNFs through the both acute outbreak crises and more long-term, chronic challenges as well as they could,” lead researcher Emily Gadbois, PhD, told McKnight’s Long-Term Care News Tuesday.

The paper’s publication follows closely behind the House Select Subcommittee on the Coronavirus Crisis’s final report, which largely criticized nursing home staffing, wages and vaccination rates.

The interviews identified four stages administrators endured. In the beginning of the pandemic, administrators described an initial shock marked by fear and confusion, and frequently changing and conflicting policies and regulations. 

“The phrase ‘the new normal’ was used to describe the second stage when administrators noted that residents, staff, and families began to adjust to life with COVID-19, albeit with more masking and distancing,” the report said. “In cases of a second outbreak, many administrators described increased confidence in knowing how to respond.”

The third stage of the pandemic began with the approval of vaccinations for emergency use and their distribution to nursing homes. Administrators also used the phrase “a light at the end of the tunnel” as vaccination rates and morale both rose. 

“When variants of COVID-19 continued, even after the availability of vaccinations, administrators then described a fourth stage marked by a dimming of hope and caregiver fatigue,” the report said. “In a final interview, one administrator noted: ‘We survive it hour-by-hour. It used to be day-by-day. Now, it’s hour-by- hour.’”

Gadbois’ interviewees frequently complained of the many changes of health crisis policy by all levels of government, according to researchers. Another common woe was how restrictions on visitation, dining and activity wore down residents’ mental health, leading to depression and weight loss.

“We heard a lot about strategies to respond to COVID-19 and its impacts on resident and staff wellbeing, and this paper highlights some of the high-level findings across a number of topics. In future papers that are in preparation we’ll be able to provide greater detail,” said Gadbois, assistant professor of health services, policy and practice at Brown University School of Public Health.