Nearly a quarter of healthcare support workers in nursing homes and other residential care settings struggle with hunger, according to a first-of-its kind study published in Health Affairs Wednesday.

Researchers combed through six years of data to measure food insecurity among American healthcare workers and found that frontline, low-level workers in the skilled nursing industry were among the most likely to miss meals or choose less healthy foods due to cost.

Nearly 16% of all healthcare workers in such settings experienced food insecurity, but that number rose to a “staggering” 22.7% among support workers including CNAs and therapy assistants, the study found.

“Wages tend to be higher in hospital settings than in nursing and residential settings, which might be one of the reasons why even among healthcare support workers, those employed in nursing and residential care settings are at highest risk for food insecurity,” said lead author Mithuna Srinivasan, Ph.D., principal research scientist in the healthcare department at NORC at the University of Chicago. “But the variation may also be driven by the nature of wages or the predictability of wages. Healthcare support workers are more likely to be shift and contract workers than salaried employees, so that creates some unpredictability in their wages, some periods of irregular earnings, and that may contribute to food insecurity as well.” 

Across all healthcare workers, the percentage of those reporting food insecurity at least once in the last month hit 6.6% —  lower than the 10.5% U.S. average. Findings were based on a USDA food security survey module. Across the board, practitioners, technicians and support workers in skilled nursing facilities struggled more with food security than their peers in hospitals or ambulatory care settings.

Regardless of the setting where they worked, 25.4% of all healthcare support workers received federal Supplemental Nutrition Assistance Program benefits in the prior year, and 32.3% had some type of nutrition-related chronic condition.

Gnawing at SNF workers

It’s highly likely that these socio-economic factors, combined with struggles to access healthy food and enough of it, are taking a toll on nursing home staff.

Mithuna Srinivasan, Ph.D.

“Insofar as healthcare support jobs tend to be both physically demanding and psychologically strenuous — and there is evidence that links food insecurity with both physical and mental health — I think it’s plausible to think that being hungry is going to constrain the ability of a healthcare support worker to provider quality care to their patient,” Srinivasan told McKnight’s Long-Term Care News on Wednesday.

Though the study’s most recent data was from 2018, researchers expect the crisis has deepened with COVID-19 “not just because of the increase in food prices, but we also know because of the pandemic, a lot of healthcare support workers in particular, and especially women, have lost their jobs,” Srinivasan said. Others had to limit hours to remain at home with children when childcare and schools closed due to outbreaks.

Recognizing the challenge of accessing food during the pandemic, some nursing home operators provided meals or restaurant gift cards as employee incentives. But those solutions tend to be “short-lived,” Srinivasan said. Follow-up studies based on surveys with affected workers could determine how well understood food insecurity issues are by employers and help pinpoint effective long-term solutions, she said. 

“Some examples of structural solutions that employers and policymakers could consider would include wage increases; at a policy level minimum wage increases; and more equitable human resources policies like benefit packages that maximize take-home pay and provide other types of non-traditional benefits like referrals to community resources, childcare, cafeteria meals and employee housing programs,” she added.