Trends in COVID-19 cases, deaths, and staffing shortages in US nursing homes by rural and urban status

Abstract

The purpose of the study was to examine trends in COVID-19 cases, related deaths, and staffing shortages in nursing homes (NH) by rural and urban status from May 2020 to Feb 2021. Generalized linear mixed models with state-fixed effects were used to estimate the interaction effect of study period and rural/urban status on having at least: one COVID-19 case, one related death, and/or at least one week of staffing shortage using the NH COVID-19 data spanning the 40-week period. The findings revealed shortages in staff, particularly direct care providers, were greatly accelerated in rural NHs as the pandemic wore on over time. Conversely, staffing shortages in urban NHs were relatively stable despite the fluctuating COVID-19 cases over the same time period. The findings highlight the need of identifying effective strategies that prevent rural NHs from encountering staffing deficits in response to long-lasting natural disasters such as the COVID-19 pandemic.

A review of COVID-19’s impact on modern medical systems from a health organization management perspective

“…One example can be seen with the comparison of rural versus urban nursing home establishments. Though rurality itself was not associated with COVID-19 infections or related deaths, a study involving the early pandemic period revealed that there was a higher degree of volatility in staffing shortages in rural nursing homes compared to their urban counterparts [ 40 ]. While rural nursing homes experienced a higher proportion of staffing shortages until mid-November 2020, staffing shortages in urban nursing homes were relatively stable over the same period, despite fluctuations in COVID-19 case volume.…”

Infection prevention and control in nursing homes during COVID-19: An environmental scan

“…Further, we did not specifically examine differences that might be present in rural as compared with urban settings despite the fact that staffing shortages and skill mix issues and COVID cases/deaths may differ by rural and urban location. 50 We focused primarily on frontline nursing staff rather than other personnel or administration because of their routine and prolonged proximity to residents during the provision of care as compared to other NH staff. Finally, this scan was conducted prior to the availability of COVID vaccine.…”

Protective effects of prior third dose mRNA vaccination in rural nursing home residents during SARS‐CoV‐2 outbreaks

“… 2 , 3 , 4 , 5 , 9 Moreover, many of these nursing home studies looked at primarily urban as opposed to rural NH populations. 10 , 11 This report analyzes the effect of prior vaccination of NH residents during recent outbreaks of SARS‐CoV‐2 in NHs in rural Manitoba, Canada. The dose‐response effect of mRNA vaccine in protection from infection was compared.…”

“…To date, most studies on vaccine efficacy in NHs were performed prior to the emergence of the BA.2 variant of SARS‐CoV‐2 (Omicron) as the dominant strain, and before a third vaccine dose was recommended 2–5,9 . Moreover, many of these nursing home studies looked at primarily urban as opposed to rural NH populations 10,11 . This report analyzes the effect of prior vaccination of NH residents during recent outbreaks of SARS‐CoV‐2 in NHs in rural Manitoba, Canada.…”