High Nursing Staff Turnover In Nursing Homes Offers Important Quality Information

Gandhi, Ashvin; Yu, Huizi; Grabowski, David C.

doi:10.1377/hlthaff.2020.00957

Cited by 157 publications

(121 citation statements)

References 17 publications

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“…Recent research suggests nursing home staff turnover may be very high. 28 The impact of this assumption for the results of our model would depend heavily on the levels of immunity in new staff: new staff could come from other nursing homes that have experienced outbreaks or from the general community, which would likely have lower seroprevalence. In addition, available data are from before the COVID-19 pandemic, and there may be large heterogeneity in how the pandemic affected staff employment trends.…”

Section: Discussionmentioning

confidence: 99%

Estimation of Transmission of COVID-19 in Simulated Nursing Homes With Frequent Testing and Immunity-Based Staffing

et al. 2021

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IMPORTANCE Nursing homes and other long-term care facilities have been disproportionately impacted by the COVID-19 pandemic. Strategies are urgently needed to reduce transmission in these high-risk populations. OBJECTIVE To evaluate COVID-19 transmission in nursing homes associated with contact-targeted interventions and testing. DESIGN, SETTING, AND PARTICIPANTS This decision analytical modeling study developed an agent-based susceptible-exposed-infectious (asymptomatic/symptomatic)-recovered model between July and September 2020 to examine SARS-CoV-2 transmission in nursing homes.Residents and staff of a simulated nursing home with 100 residents and 100 staff split among 3 shifts were modeled individually; residents were split into 2 cohorts based on COVID-19 diagnosis. Data were analyzed from September to October 2020. EXPOSURES In the resident cohorting intervention, residents who had recovered from COVID-19 were moved back from the COVID-19 (ie, infected with SARS-CoV-2) cohort to the non-COVID-19 (ie, susceptible and uninfected with SARS-CoV-2) cohort. In the immunity-based staffing intervention, staff who had recovered from COVID-19 were assumed to have protective immunity and were assigned to work in the non-COVID-19 cohort, while susceptible staff worked in the COVID-19 cohort and were assumed to have high levels of protection from personal protective equipment. These interventions aimed to reduce the fraction of people's contacts that were presumed susceptible (and therefore potentially infected) and replaced them with recovered (immune) contacts. A secondary aim of was to evaluate cumulative incidence of SARS-CoV-2 infections associated with 2 types of screening tests (ie, rapid antigen testing and polymerase chain reaction [PCR] testing) conducted with varying frequency. MAIN OUTCOMES AND MEASURES Estimated cumulative incidence proportion of SARS-CoV-2 infection after 3 months.RESULTS Among the simulated cohort of 100 residents and 100 staff members, frequency and type of testing were associated with smaller outbreaks than the cohorting and staffing interventions. The testing strategy associated with the greatest estimated reduction in infections was daily antigen testing, which reduced the mean cumulative incidence proportion by 49% in absence of contacttargeted interventions. Under all screening testing strategies, the resident cohorting intervention and the immunity-based staffing intervention were associated with reducing the final estimated size of the outbreak among residents, with the immunity-based staffing intervention reducing it more (eg, by 19% in the absence of testing) than the resident cohorting intervention (eg, by 8% in the absence of testing). The estimated reduction in transmission associated with these interventions among staff varied by testing strategy and community prevalence. (continued) Key Points Question What are the associations of cohorting, staffing, and testing interventions with COVID-19 transmission in nursing homes? Findings In this decision analytical modeling study ...

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Section: Discussionmentioning

confidence: 99%

Estimation of Transmission of COVID-19 in Simulated Nursing Homes With Frequent Testing and Immunity-Based Staffing

et al. 2021

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“…In our sample, a majority (58%) of the for-profit nursing homes were higher quality with a star rating of 3 or above. Recent reports are suggestive of for-profit facilities relying on part time workers [ 39 ] and struggling to retain their staff over time [ 40 ]. Additionally, an increasingly higher intake of COVID-19 patients by for-profit nursing homes without commensurate increase in staffing especially those trained in specialty services [ 41 ] may have put further stress resulting in higher staff turnovers.…”

Section: Discussionmentioning

confidence: 99%

Interpreting COVID-19 deaths among nursing home residents in the US: The changing role of facility quality over time

Gupta

Kelekar

Turner³

et al. 2021

PLoS ONE

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A report published last year by the Centers for Medicare & Medicaid Services (CMS) highlighted that COVID-19 case counts are more likely to be high in lower quality nursing homes than in higher quality ones. Since then, multiple studies have examined this association with a handful also exploring the role of facility quality in explaining resident deaths from the virus. Despite this wide interest, no previous study has investigated how the relation between quality and COVID-19 mortality among nursing home residents may have changed, if at all, over the progression of the pandemic. This understanding is indeed lacking given that prior studies are either cross-sectional or are analyses limited to one specific state or region of the country. To address this gap, we analyzed changes in nursing home resident deaths across the US between June 1, 2020 and January 31, 2021 (n = 12,415 nursing homes X 8 months) using both descriptive and multivariable statistics. We merged publicly available data from multiple federal agencies with mortality rate (per 100,000 residents) as the outcome and CMS 5-star quality rating as the primary explanatory variable of interest. Covariates, based on the prior literature, consisted of both facility- and community-level characteristics. Findings from our secondary analysis provide robust evidence of the association between nursing home quality and resident deaths due to the virus diminishing over time. In connection, we discuss plausible reasons, especially duration of staff shortages, that over time might have played a critical role in driving the quality-mortality convergence across nursing homes in the US.

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“…First, vaccination coverage of staff members has plateaued, suggesting further efforts are needed to increase coverage in these important healthcare personnel. Historically, high staff turnover rates at NHs— approximating 100 percent annually 12 —warrant ongoing COVID-19 vaccination efforts. Additionally, addressing vaccine hesitancy of NH staff 13-15 and improving vaccine acceptance is needed.…”

Section: Discussionmentioning

confidence: 99%

Surveillance of COVID-19 vaccination in US nursing homes, December 2020-April 2021

Ai¹,

Dubendris

et al. 2021

Preprint

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Monitoring COVID-19 vaccination coverage among nursing home (NH) residents and staff is important to ensure high coverage and guide patient-safety policies. With the termination of the federal Pharmacy Partnership for Long-Term Care Program, another source of facility-based vaccination data is needed. We compared numbers of COVID-19 vaccinations administered to NH residents and staff reported by pharmacies participating in the temporary federal Pharmacy Partnership for Long-Term Care Program with those reported by NHs participating in new COVID-19 vaccination modules of CDC's National Healthcare Safety Network (NHSN). Pearson correlation coefficients comparing the number vaccinated between the two approaches were 0.89, 0.96, and 0.97 for residents and 0.74, 0.90, and 0.90 for staff, in the weeks ending January 3, 10, and 17, respectively. Based on subsequent NHSN reporting, vaccination coverage with ≥1 vaccine dose reached 77% for residents and 50% for staff the week ending January 31 and plateaued through April 2021.

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High Nursing Staff Turnover In Nursing Homes Offers Important Quality Information

Cited by 157 publications

References 17 publications

Estimation of Transmission of COVID-19 in Simulated Nursing Homes With Frequent Testing and Immunity-Based Staffing

Estimation of Transmission of COVID-19 in Simulated Nursing Homes With Frequent Testing and Immunity-Based Staffing

Interpreting COVID-19 deaths among nursing home residents in the US: The changing role of facility quality over time

Surveillance of COVID-19 vaccination in US nursing homes, December 2020-April 2021

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