Nursing home staffing issues were a concern years before COVID-19 surfaced, particularly regarding the health, treatment and safety of the vulnerable individuals in a facility’s care.

Using 2018 data, the Department of Health and Human Services (HHS) Office of the Inspector General (OIG) requested that the Centers for Medicare and Medicaid Services (CMS) pay greater attention to day-to-day staffing levels and enforce its standards.

Since COVID-19 emerged, these long-existing issues were quickly exacerbated by the lack of personal protective equipment available, low-paid aides bringing the virus in after working across multiple nursing homes, and already-stretched facilities seeing a staff drop.

These factors not only made it difficult for a nursing home to develop a controlled, orchestrated response to protect their patients, but multiple studies have shown that lower staffing levels correlate with more widespread COVID-19 cases.

Emerging Issues

elderly hands on caneAn editorial titled “Uncovering the Devaluation of Nursing Home Staff During COVID-19: Are We Fueling the Next Health Care Crisis?” highlighted how the virus has worsened structural deficiencies.

Understaffing prior to the pandemic posed challenges for employees monitoring resident symptoms, including observing and implementing control protocols for dementia patients, who may not have a strong understanding of what’s going on or may display atypical symptoms.

At the same time, when a facility’s staff is spread too thin, social distancing is next to impossible, particularly when caring for long-term patients who need assistance with bathing and other daily tasks.

As another factor, nursing homes had some help prior to the pandemic, with family members regularly visiting to assist residents with care. With facilities now restricting visitation, this volunteered source of assistance is gone.

Added to this, as workers come down with COVID-19 symptoms, facilities may be operating on a daily basis due to illness-related absenteeism, employees quitting and, in terms of hiring, reluctance to start a career in healthcare during a pandemic.

As one study pointed out, staffing levels correlate with the lack of available PPE. Published in Health Affairs, the study found that 20 percent of all CMS facilities have experienced severe PPE shortages during the pandemic, particularly for N95 masks and gowns, and levels remained unchanged from May into June. After examining data on CMS facilities, researchers found that homes with the greatest degree of PPE shortages were also understaffed and had lower quality scores overall.

How Residents Are Impacted

Multiple studies have shown that understaffed facilities have more residents contracting COVID-19. A study published in JAMA examined CMS facilities in eight states. Facilities with higher ratings for staffing tended to experience fewer cases of COVID-19, while homes with lower staffing ratings tended to experience more instances.

Ratings on care quality and health inspections did not appear to have an impact on disease spread in the facility. In these instances, staffing included both nurses and aides.

Locally, a study involving 215 Connecticut nursing homes with confirmed COVID-19 cases found that higher staffing levels were associated with 22 percent fewer cases and 26 percent fewer related deaths.
Have decreased staffing levels impacted your loved one’s care to the point of nursing home negligence? Trantolo & Trantolo believes our elderly population should be honored, cherished and protected. To pursue your claim, contact us today.