State Policy Responses to COVID-19 in Nursing Homes

Houtven, Courtney Harold Van; Miller, Katherine; Gorges, Rebecca J.; Campbell, Hilary; Dawson, Walter D.; McHugh, John; McGarry, Brian E.; Gilmartin, Ryan; Boucher, Nathan A.; Kaufman, Brystana G.; Chisholm, Latarsha; Beltran, Susanny J.; Fashaw, Shekinah; Wang, Xiaochuan; Reneau, Olivia; Chun, Alice Min Soo; Jacobs, Josephine; Abrahamson, Kathleen; Unroe, Kathleen T.; Bishop, Clayton; Arling, Gregory; Kelly, Sheila; Werner, Rachel M.; Konetzka, R. Tamara; Norton, Edward C.

doi:10.31389/jltc.81

Cited by 17 publications

(22 citation statements)

References 16 publications

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“…20 , 21 These teams can be organized at the state or federal level and could provide supplemental staffing to facilities experiencing severe outbreaks. 22 The American Rescue Plan Act of 2021 provided temporary funding for such teams, and anecdotal reports indicate that they were helpful in addressing emergency staff shortages. 23 , 24 Policy makers might also consider broad investment in nursing home workers through better pay and benefits, such as increasing Medicaid reimbursements alongside wage pass-through requirements.…”

Section: Discussionmentioning

confidence: 99%

“…In light of the considerable challenges documented in this cohort study, preparations for future infectious disease outbreaks should include emergency staffing plans for nursing homes to ensure resident safety, such as centralized “strike teams” that can be temporarily deployed . These teams can be organized at the state or federal level and could provide supplemental staffing to facilities experiencing severe outbreaks . The American Rescue Plan Act of 2021 provided temporary funding for such teams, and anecdotal reports indicate that they were helpful in addressing emergency staff shortages .…”

Section: Discussionmentioning

confidence: 99%

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Staffing Patterns in US Nursing Homes During COVID-19 Outbreaks

et al. 2022

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IMPORTANCEStaff absences and departures at nursing homes may put residents at risk and present operational challenges. OBJECTIVE To quantify changes in nursing home facility staffing during and after a severe COVID-19 outbreak. DESIGN, SETTING, AND PARTICIPANTSIn this cohort study, daily staffing payroll data were used to construct weekly measures of facility staffing, absences, departures, and use of overtime and contract staff among US nursing homes experiencing a severe COVID-19 outbreak that started between June 14, 2020, and January 1, 2021. Facility outbreaks were identified using COVID-19 case data. An event-study design with facility and week fixed effects was used to investigate the association of severe outbreaks with staffing measures.EXPOSURES Weeks since the beginning of a severe COVID-19 outbreak (4 weeks prior to 16 weeks after). MAIN OUTCOMES AND MEASURESTotal weekly staffing hours, staff counts, staff absences, departures, new hires, overtime and contract staff hours measured for all nursing staff and separately by staff type (registered nurses, licensed practical nurses, certified nursing assistants), facility selfreported staff shortages, and resident deaths. RESULTSOf the included 2967 nursing homes experiencing severe COVID-19 outbreaks, severe outbreaks were associated with a statistically significant drop in nursing staffing levels owing to elevated absences and departures. Four weeks after an outbreak's start, around when average new cases peaked, staffing hours were 2.6% (95% CI, 2.1%-3.2%) of the mean below preoutbreak levels, despite facilities taking substantial measures to bolster staffing through increased hiring and the use of contract staff and overtime. Because these measures were mostly temporary, staffing declined further in later weeks; 16 weeks after an outbreak's start, staffing hours were 5.5% (95% CI, 4.5%-6.5%) of the mean below preoutbreak levels. Staffing declines were greatest among certified nursing assistants, primarily owing to smaller increases in new hires of this staff type compared with licensed practical nurses and registered nurses. CONCLUSIONS AND RELEVANCEIn this cohort study of nursing homes experiencing severe COVID-19 outbreaks, facilities experienced considerable staffing challenges during and after outbreaks. These results suggest the need for policy action to ensure facilities' abilities to maintain adequate staffing levels during and after infectious disease outbreaks.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Staffing Patterns in US Nursing Homes During COVID-19 Outbreaks

et al. 2022

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“…Examples included wearing facemasks, hand washing, using PPE, and nonpunitive sick leave policies that allow potentially contagious staff to stay out of work (CMS, 2020). To avoid further clusters of infections, recommendations also included guidelines on how to segregate residents who were infected, as well as to segregate units/wings and work assignments among the direct care workers (CMS, 2020; Van Houtven et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Post-Acute and Long-Term Care Leaders’ Perspectives on Leading During COVID-19

2023

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Post-acute and long-term care (PALTC) delivery is complex, and the COVID-19 pandemic created additional complexities. This qualitative study investigates how PALTC administrators responded to the pandemic, factors that impacted their leadership role and decision-making. Participants from North Carolina ( N = 15) and Pennsylvania ( N = 6) were interviewed using an interview guide containing open-ended questions. The results revealed three themes: (1) critical knowledge and competencies; (2) resources, supports and essential actions taken; and (3) psychosocial impact. The findings suggest communication and relationship building were the most useful competencies. Lack of staff was a primary stress point during and after the pandemic.

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“…A number of states have launched similar efforts to mitigate the spread of COVID‐19, 10 and the Center for Medicare and Medicaid Services has issued infection prevention and control recommendations. 11 However, their success has been limited 12 and to our knowledge, none of the state‐wide interventions has been rigorously studied for its impact on infection rates. A recent rapid narrative review by Dykgraaf et al 13 identified 77 observational studies in a variety of long‐term care settings from around the world that suggested widespread surveillance, early identification and response, and rigorous infection prevention and control measures were most effective in mitigating the spread of COVID‐19.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a state‐wide effort to improve COVID‐19 infection control in Massachusetts nursing homes

Lipsitz

Kosar

Dufour

et al. 2022

J American Geriatrics Society

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Background During the deadly 2020 SARS‐CoV‐2 surge in nursing homes (NHs), Massachusetts (MA) initiated a multicomponent infection control intervention to mitigate its spread. Methods We aimed to assess the intervention's impact by comparing the weekly risk of PCR‐confirmed infections among MA NH residents to those in neighboring New England states, all managed similarly by a single NH provider. We studied 2085 residents in 20 MA NHs and 4493 residents in 45 comparator facilities. The intervention included: (1) A 28‐item infection control checklist of best practices, (2) incentive payments to NHs contingent on scoring ≥24 on the checklist, meeting 6 core competencies, testing residents and staff for SARS‐COV‐2 RNA, uploading data, and enabling virtual visits; (3) on‐site and virtual infection control consultations for deficient facilities; (4) 6 weekly webinars; (5) continuous communication with the MA Department of Public Health; and (6) access to personal protective equipment, temporary staff, and SARS‐CoV‐2 testing. Weekly rates of infection were adjusted for county COVID‐19 prevalence. Results The adjusted risk of infection started higher in MA, but declined more rapidly in its NHs compared to similarly managed facilities in other states. The decline in infection risk during the early intervention period was 53% greater in MA than in Comparator States (state‐by‐time interaction HR = 0.47; 95% CI 0.37–0.59). By the late intervention period, the risk of infection continued to decline in both groups, and the change from baseline in MA was marginally greater than that in the Comparator States (interaction HR 0.80; 95% CI 0.64–1.00). Conclusions The MA NH intervention was associated with a more rapid reduction in the rate of SARS‐CoV‐2 infections compared to similarly managed NHs in neighboring states. Although several unmeasured factors may have confounded our results, implementation of the MA model may help rapidly reduce high rates of infection and prevent future COVID‐19 surges in NHs.

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State Policy Responses to COVID-19 in Nursing Homes

Cited by 17 publications

References 16 publications

Staffing Patterns in US Nursing Homes During COVID-19 Outbreaks

Staffing Patterns in US Nursing Homes During COVID-19 Outbreaks

Post-Acute and Long-Term Care Leaders’ Perspectives on Leading During COVID-19

Evaluation of a state‐wide effort to improve COVID‐19 infection control in Massachusetts nursing homes

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