A qualitative assessment of factors affecting nursing home caregiving staff experiences during the COVID-19 pandemic

Abstract

Background A large portion of COVID-19 cases and deaths in the United States have occurred in nursing homes; however, current literature including the frontline perspective of staff working in nursing homes is limited. The objective of this qualitative assessment was to better understand what individual and facility level factors may have contributed to the impact of COVID-19 on Certified Nursing Assistants (CNAs) and Environmental Services (EVS) staff working in nursing homes. Methods Based on a simple random sample from the National Healthcare Safety Network (NHSN), 7,520 facilities were emailed invitations requesting one CNA and/or one EVS staff member for participation in a voluntary focus group over Zoom. Facility characteristics were obtained via NHSN and publicly available sources; participant demographics were collected via SurveyMonkey during registration and polling during focus groups. Qualitative information was coded using NVIVO and Excel. Results Throughout April 2021, 23 focus groups including 110 participants from 84 facilities were conducted homogenous by participant role. Staffing problems were a recurring theme reported. Participants often cited the toll the pandemic took on their emotional well-being, describing increased stress, responsibilities, and time needed to complete their jobs. The lack of consistent and systematic guidance resulting in frequently changing infection prevention protocols was also reported across focus groups. Conclusions Addressing concerns of low wages and lack of financial incentives may have the potential to attract and retain employees to help alleviate nursing home staff shortages. Additionally, access to mental health resources could help nursing home staff cope with the emotional burden of the COVID-19 pandemic. These frontline staff members provided invaluable insight and should be included in improvement efforts to support nursing homes recovering from the impact of COVID-19 as well as future pandemic planning.

Who’s in the House? Staffing in Long-Term Care Homes Before and During COVID-19 Pandemic

“…There is evidence that unregulated staff such as personal support workers and other support or assistant staff saw a dramatic increase in their workloads and experienced shifting of tasks due to a lack of regulated staff (Doctors Without Borders, n.d.; Jacobsen et al, 2021; Spilsbury et al, 2020). Many additional barriers led to further worsening of COVID-19 case numbers in the LTC homes for those who remained in the home during the pandemic, for example, staffing shortages, frequent staff turnover, lack of leadership support, lack of PPE, and lack of training and education (Snyder et al, 2021). COVID-19 pandemic provided an opportunity for natural experiments where members of different disciplines tried their best to provide for their residents’ need.…”

Promoting empowerment for people living with dementia in nursing homes: Development and feasibility evaluation of an empowerment program

“…However, this might not be a valid reason for the research team to discontinue the further development and evaluation, as due to the hindrance of the COVID-19 outbreak, results should be interpreted with caution. During the COVID-19 pandemic, healthcare professionals had to work under complex and stressful circumstances ( Snyder et al, 2021 ; White et al, 2021 ). Considering the high workload due to COVID-19 related priorities, the lower number of healthcare professionals who were able to participate, and COVID-19 restrictions, such as a maximum number of healthcare professionals that could attend a meeting, results could have been negatively affected.…”

Managing the Impact of COVID-19 in Nursing Homes and Long-Term Care Facilities: An Update

“…209 Studies examining staff resignations highlight the importance of effective employer communication, particularly in emergencies, 210 and an increased focus on communication and support, with access to mental health support, for nursing home staff is imperative at an organizational level. 211 Importantly, issues around low wages and lack of financial incentives may need to be resolved in order to attract and retain additional staff within the sector. 211…”

“…211 Importantly, issues around low wages and lack of financial incentives may need to be resolved in order to attract and retain additional staff within the sector. 211…”