Shortages of Staff in Nursing Homes During the COVID-19 Pandemic: What are the Driving Factors?

Xu, Huiwen; Intrator, Orna; Bowblis, John R.

doi:10.1016/j.jamda.2020.08.002

Cited by 141 publications

(124 citation statements)

References 22 publications

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“…Having patients with COVID-19 and supply shortages correlated with staff resignations and can be overcome with adequate stockpiling, support from state public health, local hospitals as well as parent corporations. 22 Facilities were prompt in providing education and training to their staff with 80.0% of respondents providing in-person one-on-one training to their frontline staff on PPE use, and 71.7% providing one-on-one training on obtaining nasopharyngeal swabs. A majority of the respondents also provided rapid communications to their staff reflecting their commitment to transparency.…”

Section: Discussionmentioning

confidence: 99%

When planning meets reality: COVID-19 interpandemic survey of Michigan Nursing Homes

Jones

Mantey

Washer

et al. 2021

American Journal of Infection Control

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Background Nursing home (NH) populations have borne the brunt of morbidity and mortality of COVID-19. We surveyed Michigan NHs to evaluate preparedness, staffing, testing, and adaptations to these challenges. Methods Inter-pandemic survey responses were collected May 1-12, 2020. We used Pearson's Chi-squared test, Fisher's exact test, and logistic regression to evaluate relationships. Results Of 452 Michigan NHs contacted via email, 145 (32.1%) opened the survey and of these, 143 (98.6%) responded. Sixty-eight percent of respondents indicated their response plan addressed most issues. NHs reported receiving rapidly changing guidance from many sources. Two-thirds reported shortages of personal protective equipment and other supplies. Half (50%) lacked sufficient testing resources with only 36% able to test residents and staff with suspected COVID-19. A majority (55%) experienced staffing shortages. Sixty-three percent experienced resignations, with front-line clinical staff more likely to resign, particularly in facilities caring for COVID-19 patients (p<0.001). Facilities adapted quickly, creating COVID-19 units (78%) to care for patients on site. To reduce isolation, NHs facilitated communication via phone calls (98%), videoconferencing (96%), and window visits (81%). A majority continued to provide requisite therapies (90%). Conclusion NHs experienced shortages of resources, testing supplies, and staffing challenges. COVID-19 in the facility was a key predictor of staff resignations. Facilities relied on rapidly changing, often conflicting advice from multiple sources, suggesting high-yield areas of improvement.

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Section: Discussionmentioning

confidence: 99%

When planning meets reality: COVID-19 interpandemic survey of Michigan Nursing Homes

Jones

Mantey

Washer

et al. 2021

American Journal of Infection Control

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“…However, this recommendation can be difficult to implement, because nursing homes often face a staff shortage, making the situation worse. Indeed, a study in the USA highlighted that nursing homes “having any residents or staff with Covid-19 were significantly more likely to experience shortages of all types of staff” [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

High impact of COVID-19 outbreak in a nursing home in the Nouvelle-Aquitaine region, France, March to April 2020

et al. 2021

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Background Elderly people in nursing homes are particularly vulnerable to COVID-19 due to their age, the presence of comorbidities, and community living. On March 14, 2020, at the beginning of the first epidemic wave of COVID-19 in France, a cluster was reported in a nursing home in the Nouvelle-Aquitaine region. We monitored the outbreak as well as the infection prevention and control (IPC) measures implemented. Methods A confirmed case was defined as laboratory-confirmed COVID-19 in a resident or staff member present in the nursing home between March 7 and May 1, 2020; and a probable case as a person presenting an acute respiratory illness after contact with a confirmed case. Symptomatic inpatient residents and symptomatic staff members were systematically tested for SARS-CoV-2. In addition, two screening sessions were held on site. Results We identified 109 cases (98 confirmed, 11 probable). The attack rate was 66% among residents and 45% among staff. Half of all cases were identified during the screening sessions. One-quarter of cases had minor symptoms or were asymptomatic. The case fatality rate among residents was 29%. IPC measures were rapidly implemented such as the quarantine of residents, the reinforcement of staff personal protective equipment, and home quarantine of staff testing positive, which were supplemented in April by systematic controls at the entrance of the nursing home and the creation of additional staff break rooms. Conclusions This outbreak confirmed the considerable health impact of SARS-CoV-2 transmission in a nursing home. In addition to the implementation of IPC measures, the early detection of cases through the screening of residents and staff is essential to identify asymptomatic and pre-symptomatic cases and limit the spread of the virus.

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“…The main concerns related to systematic missing data and selection bias in the included studies. For example, studies that investigated the characteristics of care homes excluded from the CMS dataset (due to missing or incomplete data) found that such facilities were more likely to be FPs and also correlated to many risk factors, such as the ethnicity and socio-economic status of residents (discussed in detail below) 29,41,43,45 . This is a potentially serious limitation of the studies using this data (for the purpose of this review), as it suggests that poorly performing FPs may be systematically underrepresented in the sample, which may underestimate the observed effect of ownership on COVID-19 outcomes.…”

Section: Risk Of Bias Assessmentsmentioning

confidence: 99%

Ownership and COVID-19 in care homes for older people: A living systematic review of outbreaks, infections, and mortalities

Bach-Mortensen

Verboom

Esposti

2021

Preprint

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BackgroundThe adult social care sector is being increasingly outsourced to for-profit providers, but the impacts of privatisation on service quality and resident outcomes are unclear. During the COVID-19 pandemic, for-profit providers have been accused of failing their residents by prioritising profits over care, prevention, and caution, which has been reported to result in a higher prevalence of COVID-19 infections and deaths in for-profit care homes. Although many of these reports are anecdotal or based on news reports, there is a growing body of academic research investigating ownership variation across COVID-19 outcomes, which has not been systematically appraised and synthesised.ObjectivesTo identify, appraise, and synthesise the available research on ownership variation in COVID-19 outcomes (outbreaks, infections, deaths, shortage of personal protective equipment (PPE) and staff) across for-profit, public, and non-profit care homes for older people, and to update our findings as new research becomes available.DesignLiving systematic review.MethodsThis review was prospectively registered with Prospero (CRD42020218673). We searched 17 databases and performed forward and backward citation tracking of all included studies. Search results were screened and reviewed in duplicate. Risk of bias (RoB) was assessed in duplicate according to the COSMOS-E guidance. The results were synthesised according to RoB, model adjustment, and country context and visualised using harvest plots.ResultsTwenty-eight studies across five countries were included, with 75% of included studies conducted in the Unites States. For-profit ownership was not consistently associated with a higher probability of COVID-19 outbreaks across included studies. However, there was compelling evidence of worse COVID-19 outcomes following an outbreak; with for-profit care homes having higher rates of accumulative infections and deaths. For-profit providers were also associated with shortages in PPE, which may have contributed to the higher incidence of infections and deaths.Chain affiliation was often found to be correlated with higher risk of outbreaks, but not consistently associated with an elevated number of deaths and infections. Private equity ownership was not consistently associated with worse COVID-19 outcomes.ConclusionFor-profit status was a consistent risk factor for higher cumulative COVID-19 infections and deaths. Thus, ownership among providers may be a key modifiable factor which can be regulated to improve health outcomes in vulnerable populations and reduce health disparities. This review will be updated as new research becomes published, which may change the conclusion of our synthesis.

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Shortages of Staff in Nursing Homes During the COVID-19 Pandemic: What are the Driving Factors?

Cited by 141 publications

References 22 publications

When planning meets reality: COVID-19 interpandemic survey of Michigan Nursing Homes

When planning meets reality: COVID-19 interpandemic survey of Michigan Nursing Homes

High impact of COVID-19 outbreak in a nursing home in the Nouvelle-Aquitaine region, France, March to April 2020

Ownership and COVID-19 in care homes for older people: A living systematic review of outbreaks, infections, and mortalities

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