Staffing Patterns in US Nursing Homes During COVID-19 Outbreaks

Area of Science:

• Healthcare Management
• Epidemiology
• Gerontology

Background:

• Nursing home staff absences and departures pose risks to residents and operational stability.
• The COVID-19 pandemic severely impacted healthcare staffing, particularly in long-term care facilities.

Purpose of the Study:

• To quantify the changes in nursing home staffing levels during and after severe COVID-19 outbreaks.
• To analyze the impact of outbreaks on staff absences, departures, and the utilization of temporary staffing.

Main Methods:

• A cohort study analyzing weekly staffing payroll data from 2967 US nursing homes experiencing severe COVID-19 outbreaks (June 2020 - January 2021).
• Utilized an event-study design with facility and week fixed effects to assess the association between severe outbreaks and staffing measures.
• Measured total weekly staffing hours, staff counts, absences, departures, new hires, and use of overtime/contract staff.

Main Results:

• Severe COVID-19 outbreaks led to significant drops in nursing staffing, with hours 2.6% below pre-outbreak levels by week 4 and 5.5% by week 16.
• Despite increased hiring and use of contract staff/overtime, staffing levels declined, most notably among certified nursing assistants.
• Staffing challenges persisted long after the peak of new cases, indicating a prolonged impact on facility operations.

Conclusions:

• Nursing homes faced substantial staffing challenges during and after severe COVID-19 outbreaks.
• Findings underscore the need for policy interventions to support sustained adequate staffing levels in long-term care during public health emergencies.