Perspectives of nursing home administrators across the United States during the COVID‐19 pandemic

Abstract

Objective To characterize the experiences of nursing home administrators as they manage facilities across the United States during the COVID‐19 pandemic. Data Sources and Study Setting We conducted 156 interviews, consisting of four repeated interviews with administrators from 40 nursing homes in eight health care markets across the country from July 2020 through December 2021. Study Design We subjected the interview transcripts to a rigorous qualitative analysis to identify overarching themes using a modified grounded theory approach to applied thematic analysis. Data Collection Methods In‐depth, semi‐structured qualitative interviews were conducted virtually or by phone, and audio‐recorded, with participants' consent. Audio recordings were transcribed. Principal Findings Interviews with nursing home administrators revealed a number of important cross‐cutting themes. In interviewing each facility's administrator four times over the course of the pandemic, we heard perspectives regarding the stages of the pandemic, and how they varied by the facility and changed over time. We also heard how policies implemented by federal, state, and local governments to respond to COVID‐19 were frequently changing, confusing, and conflicting. Administrators described the effect of COVID‐19 and efforts to mitigate it on residents, including how restrictions on activities, communal dining, and visitation resulted in cognitive decline, depression, and weight loss. Administrators also discussed the impact of COVID‐19 on staff and staffing levels, reporting widespread challenges in keeping facilities staffed as well as strategies used to hire and retain staff. Administrators described concerns for the sustainability of the nursing home industry resulting from the substantial costs and pressures associated with responding to COVID‐19, the reductions in revenue, and the negative impact of how nursing homes appeared in the media. Conclusions Findings from our research reflect nursing home administrator perspectives regarding challenges operating during COVID‐19 and have substantial implications for policy and practice.

Examination of Staffing Shortages at US Nursing Homes During the COVID-19 Pandemic

“…Markets varied based on US region and nursing home use patterns. Using purposive sampling, 5 nursing homes that varied by 5-star rating, size, payer mix, and profit status were selected in each market . Administrators were recruited by email and telephone to participate in semistructured interviews.…”

Caring for nursing home residents with dementia during the COVID‐19 pandemic: Perspectives from administrators

“…Interviews examined administrator perspectives as they managed nursing homes across the stages of the pandemic. 6,7 This report synthesizes their responses to questions regarding the care of residents with dementia. Participants were recruited by email to participate in 60-min videoconference or telephone interviews every 3 months for a total of four interviews each.…”

“…About 156 interviews were conducted July 2020–December 2021 with administrators of 40 nursing homes that varied by healthcare market and organizational characteristics (Supplemental Figure 1 and Table 1). Interviews examined administrator perspectives as they managed nursing homes across the stages of the pandemic 6,7 . This report synthesizes their responses to questions regarding the care of residents with dementia.…”

Psychological and Structural Burdens and Nursing Home Administrator Turnover Intentions During the COVID-19 Pandemic

“…COVID-related stress impacted healthcare professionals globally, increasing job stress, strain, and dissatisfaction, leading to increased employee turnover intent (TI) and, for many, actual job abandonment (Gadbois et al, 2022;Hou et al, 2021;Rotenstein et al, 2023). Nursing home administrators (NHAs) were not immune to the psychological pressures posed by COVID-19's challenges (Gadbois et al, 2022).…”

“…COVID-related stress impacted healthcare professionals globally, increasing job stress, strain, and dissatisfaction, leading to increased employee turnover intent (TI) and, for many, actual job abandonment (Gadbois et al, 2022;Hou et al, 2021;Rotenstein et al, 2023). Nursing home administrators (NHAs) were not immune to the psychological pressures posed by COVID-19's challenges (Gadbois et al, 2022). Not only did NHAs have to deal with high resident infection and death rates (Chidambaram, 2022;Gadbois et al, 2022) but also with bad press, (Gadbois et al;Lane et al, 2023), a negative public image (Reinhart et al, 2022), quarantines, protective equipment shortages, fiscal meltdowns (Human Rights Watch, 2021;LaPointe, 2020), sinking occupancy rates (Reinhardt et al), and the effects of resident isolation (Gadbois et al).…”