Lack of staffing in nursing homes during the COVID-19 pandemic
Lack of staffing in nursing homes during the COVID-19 pandemic

Lack of staffing in nursing homes during the COVID-19 pandemic

The disproportionate impact of the COVID-19 pandemic on residents and staff of nursing homes has brought increased attention to long-term workforce issues that can affect care quality and safety, such as staff shortages and high turnover rates. These problems have been around for decades and have been associated with adverse results, including increased mortality, hospitalization rates and emergency room visits. Since the beginning of the pandemic is more than 200,000 COVID-19 deaths has occurred among long-term carers and staff, with most of these deaths (150,000 COVID-19 deaths) occurs among residents and staff at care facilities who are certified to receive Medicare and / or Medicaid payments. In response to these issues, the Biden Administration recently announced a set of nursing home reformswhich was highlighted in State of the Union address.

This analysis presents the latest data at national and state level on reported staff shortages in care institutions and describes Biden Administration’s new policy initiatives to solve staff and other quality problems in care facilities. National trend data for staff shortages range from May 2020, the first month in which nursing homes were required to report COVID-19 facility data to the CDC, to February 27, 2022, the most recent week of available data. See it Methods box below for more details.

1. What do the data on staffing in nursing homes show?

From the week ending February 27, 2022, the latest available data, 29% of care facilities reported at least one staff shortage (approximately 4,000 out of 14,000 facilities) (Figure 1). The current rate represents a slight decrease since the week ending January 23, 2022, when the proportion of nursing facilities that reported staff shortages peaked at 33%. This small decline between January and February may be due in part decrease in cases related to the Omicron variant as well as other potential factors, including anecdotal accounts of care facilities that offer higher wages to attract workers. The current rate, 29%, is higher than the rate reported in May 2020, where 22% of care facilities reported at least one type of staff shortage.

The current level of staff shortages coincides with a period in which healthcare providers, including care facilities, struggled with the impact of Omicron variant, a highly transferable variant that broke case and hospitalization records. This variant primarily affected residents and staff who were not vaccinated or boosted, although vaccinated elderly adults and people with other health conditions still faced a high risk of infection and mortality.

Nursing facilities were most likely to report shortages of assistants and least likely to report shortages of clinical staff per. February 27, 2022. (Figure 1). Among the approximately 14,000 care facilities that report complete and reliable data for the week ending February 27th27% reported a shortage of assistants, while only 3% reported a shortage of clinical staff. Staff shortages were almost as high for nursing staff as for caregivers, with 25% of facilities reporting shortages of nursing staff. During the same period, 15% reported a shortage of other staff. These patterns have remained stable since nursing facilities began reporting this data in May 2020. In order to report staff shortages, the Centers for Medicare & Medicaid Services (CMS) defines assistants to include certified nurses (CNAs), nurses, and medical assistants or technicians. . Caregivers typically monitor overall care needs, including assistance with personal care needs and ensuring that each resident’s care plan is followed. Clinical staff primarily monitor medical needs and include physicians, assistant physicians, and advanced nurses. The nursing staff includes trained nurses, licensed practical nurses and occupational nurses.

The proportion of care facilities reporting staff shortages varies greatly from state to state (Figure 2 and Table 1). From the week ending February 27, 2022, the proportion of care facilities that reported staff shortages ranged from 3% of care facilities in California to 73% in Alaska (Figure 2, Table 1). It should be noted that less than 80% of the care facilities in Alaska reported data and passed quality checks performed by CMS.

In ten states, at least half of care facilities reported one or more staff shortages per capita. February 27, 2022. The five states with the highest proportion of care facilities reporting staff shortages include Alaska (73%), Minnesota (64%), Kansas (59%), Washington (59%) and Wyoming (57 %). Conversely, the five states with the lowest percentage of care facilities reporting staff shortages include California (3%), Connecticut (4%), Massachusetts (9%), Texas (10%) and New Jersey (10%) (Table 1). The state’s variation in staff shortages at institutional level can be attributed to variation in local economies and labor markets and may also be due to differences in the way in which nursing facilities define staff shortages.

3. What topics are important to keep an eye on?

Looking ahead, there are still open questions about how and when the new Biden policy proposals will be implemented. The specific details of what minimum levels will be proposed are not yet known and, as mentioned above, the CMS intends to conduct a study to inform about the new proposed rules. Although the administration plans to issue proposed rules within a year, it is not yet known when the new rules will be finalized or enter into force. Enforcement of the new rules are likely to be through the existing state inspection process, with facilities potentially subject to sanctions such as fines or loss of Medicare or Medicaid funding. Another open question is how stakeholder response will affect the new rules. The proposal meets fierce opposition from the nursing home industry, which claims it facilities will not be able to meet new staffing and oversight requirements without additional federal funding. Advocates of the new rules claim that minimum staff requirements are an important protection for nursing home residents. Others argue that the Biden proposal does not go far enough and should also address issues of Medicaid reimbursement rates and work compensation. It is not clear whether Congress will approve additional federal funding in addition to the pandemic aids already made available for care facilities.

Another open question is how the pandemic and CMSs the health care provider’s vaccination mandate will affect staff shortages in nursing homes. In issuing the mandate, the CMS acknowledged that some employees may leave their jobs because they do not want to receive the vaccine, but given examples of vaccine mandates adopted by health systems in Texas and Detroit and a long-term care parent company with 250 facilities as well as the mandate for health workers in the state of New York, all of which resulted in high compliance rates and few employee layoffs. Staff vaccination rates at present vary by statewhich probably reflects a mix of federal mandates that have not yet been passed, varying state and / or local mandates, and varying degrees of hesitation with vaccines among staff. Data also shows that the number of workers in care and geriatric care facilities has continued to decline, even while other health conditions have returned to near pre-pandemic levels, raising questions about the pandemic’s long-term effects on the workforce. Upcoming KFF analyzes will analyze the impact of the mandate when data is available, as well as evaluate changes in the state’s minimum staffing after COVID. It will be important to see if and how experiences from the pandemic are integrated into new policies to improve the quality of care facilities and protect residents and staff.

This analysis uses federal data on personnel reported weekly by facilities to the CDC’s National Healthcare Safety Network (NHSN) and reflects data from mid-May 2020 to February 27, 2022. These data are updated regularly to reflect revised data from previous weeks so that future versions of this data set that reflect the same time period may emit different values.

Each week, approximately 15,200 nursing facilities submit data through the NHSN, including whether they experience a shortage of nursing staff (including registered nurses, licensed practical nurses and occupational nurses), clinical staff (including physicians, medical assistants and advanced nurses), assistants (including nurses, certified nurses, and medical technicians) or other staff (including administrative staff, guardianship staff and other environmental service staff). These goals are asked and reported as binary goals (yes / no) and reflect staff shortages from the week of data reporting; therefore, we are not able to determine the extent of staff shortages among nursing facilities that report “yes” to one or more staff positions. In addition, these measures differ from other staffing adequacy measures, including the minimum staffing levels required by the federal government and states.

The CMS performs data quality checks to identify facilities that may have entered incorrect data before publishing this data for public download. Facilities that have submitted erroneous data will have an “N” displayed in the column titled “Passed Quality Assurance Check”. Our final sample of care facilities in this analysis excludes facilities that CMS has marked in their data quality checks, as well as facilities that lack deficiency measures. With these exclusions, each week’s data in Figure 1 represents anywhere from 14,100 to 15,100 facilities. Each week of data represents a slightly different set of facilities due to weekly variations in the reporting of nursing facilities. The most recent week with data, per. February 27thth, 2022, includes 14,126 care facilities. The federal data only includes data on Medicare or Medicaid certified nursing facilities. This analysis therefore does not reflect other long-term care environments, such as nursing homes, nursing homes, group homes or intermediate care facilities.


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