Nursing Facility Staffing Shortages During the COVID-19 Pandemic

The disproportionate affect of the COVID-19 pandemic on nursing facility residents and workers has introduced elevated consideration to long-standing workforce points that may have an effect on care high quality and security, resembling staffing shortages and excessive turnover charges. These points have existed for many years and have been related to adverse outcomes, together with elevated mortality charges, hospitalization charges, and emergency division visits. For the reason that onset of the pandemic, greater than 200,000 COVID-19 deaths have occurred amongst long-term care residents and workers, with most of those deaths (150,000 COVID-19 deaths) occurring amongst residents and workers in nursing services which might be licensed to obtain Medicare and/or Medicaid funds. In response to those points, the Biden Administration lately introduced a set of nursing facility reforms, which had been highlighted within the State of the Union address.

This evaluation presents the latest nationwide and state-level information on nursing facility-reported workers shortages and describes the Biden Administration’s new coverage initiatives to handle staffing and different high quality points in nursing services. Nationwide workers scarcity pattern information spans from Might 2020, the primary month when nursing services had been required to report COVID-19 facility information to the CDC, by February 27, 2022, the latest week of knowledge obtainable. See the Methods field under for extra particulars.

1.  What do the info present about nursing facility staffing?

As of the week ending February 27, 2022, the latest information obtainable, 29% of nursing services reported not less than one staffing scarcity (roughly 4,000 out of 14,000 services) (Determine 1). The present price represents a slight drop for the reason that week ending January 23, 2022, when the share of nursing services reporting a workers scarcity peaked at 33%. This slight decline between January and February  could also be partly as a result of decline in cases associated to the Omicron variant in addition to different potential components, together with anecdotal accounts of nursing services providing greater wages to draw employees. The present price, 29%, is greater than the speed reported in Might 2020, when 22% of nursing services reported not less than one kind of workers scarcity.

The present degree of workers shortages coincides with a interval when well being care suppliers, together with nursing services, grappled with the affect of the Omicron variant, a extremely transmissible variant that broke case and hospitalization information. This variant primarily affected residents and staff who weren’t vaccinated or boosted, although vaccinated older adults and people with different well being circumstances nonetheless confronted a excessive threat of an infection and mortality.

Nursing services had been most certainly to report a scarcity of aides and least prone to report a scarcity of scientific workers as of February 27, 2022. (Determine 1). Among the many roughly 14,000 nursing services reporting full and dependable information for the week ending February 27th, 27% reported aide shortages whereas simply 3% reported scientific workers shortages. Workers shortages had been almost as excessive for nursing workers as they had been for aides, with 25% of services reporting nursing workers shortages. In the identical time interval, 15% reported different workers shortages. These patterns have held regular since nursing services started reporting this information in Might 2020. For functions of reporting workers shortages, the Facilities for Medicare & Medicaid Companies (CMS) defines aides to incorporate licensed nursing assistants (CNAs), nurse aides, and medicine aides or technicians. Aides sometimes oversee total care wants, together with help with private care wants and guaranteeing that every resident’s plan of care is being adopted. Scientific workers primarily oversee medical wants and embrace physicians, doctor assistants, and superior follow nurses. Nursing workers embrace registered nurses, licensed sensible nurses, and vocational nurses.

The share of nursing services reporting staffing shortages varies extensively by state (Determine 2 and Table 1). As of the week ending February 27, 2022, the share of nursing services reporting workers shortages ranged from 3% of nursing services in California to 73% in Alaska (Determine 2, Table 1). Of be aware, lower than 80% of nursing services in Alaska reported information and handed quality-checks carried out by CMS.

In ten states, not less than half of nursing services reported a number of workers scarcity as of February 27, 2022. The 5 states with the very best shares of nursing services reporting any staffing shortages embrace Alaska (73%), Minnesota (64%), Kansas (59%), Washington (59%), and Wyoming (57%). Conversely, the 5 states with the bottom share of nursing services reporting workers shortages embrace California (3%), Connecticut (4%), Massachusetts (9%), Texas (10%), and New Jersey (10%) (Table 1). State variation in staffing shortages on the facility-level could also be attributable to variation in native economies and labor markets, and may be attributable to variations in the way in which by which nursing services outline workers shortages.

3. What points are essential to look at?

Trying forward, open questions stay about how and when the brand new Biden coverage proposals will probably be applied. The particular particulars about what minimal workers ranges will probably be proposed usually are not but identified, and as famous above, CMS intends to conduct a examine to tell the brand new proposed laws. Whereas the Administration plans to difficulty proposed guidelines inside a 12 months, it isn’t but identified when the brand new guidelines can be finalized or take impact. Enforcement of the brand new guidelines will possible be by the present state inspection course of, with services doubtlessly topic to penalties resembling fines or lack of Medicare or Medicaid funding. One other open query is how stakeholder response will have an effect on the brand new guidelines. The proposal faces stiff opposition from the nursing house business, which argues that services will probably be unable to satisfy new staffing and oversight necessities with out further federal funding. Proponents of the brand new guidelines contend that minimal staffing necessities are an essential safety for nursing house residents. Others argue that the Biden proposal doesn’t go far sufficient and must also deal with points round Medicaid reimbursement charges and employee compensation. It isn’t clear whether or not Congress will authorize further federal funding past the pandemic aid funds already offered for nursing services.

One other open query is how the pandemic and CMS’s health care provider vaccination mandate will have an effect on nursing facility staffing shortages. When issuing the mandate, CMS acknowledged that some workers might depart their jobs as a result of they don’t need to obtain the vaccine, however cited examples of vaccine mandates adopted by well being methods in Texas and Detroit and a long-term care father or mother company with 250 services in addition to the New York state well being care employee mandate, all of which resulted in excessive charges of compliance and few worker resignations. Workers vaccination charges at present vary by state, possible reflecting a mixture of federal mandate deadlines not but passing, various state and/or native mandates, and totally different levels of vaccine hesitancy amongst workers. Data additionally present that the variety of employees in nursing care and elder care services has continued to say no even whereas different well being settings have returned to almost pre-pandemic ranges, elevating questions concerning the long-term results of the pandemic on the workforce.  Forthcoming KFF analyses will analyze the affect of the mandate when information is offered, in addition to consider state minimal staffing requirement modifications post-COVID. It is going to be essential to look at whether or not and the way classes from the pandemic are built-in into new insurance policies to enhance nursing facility care high quality and shield residents and workers.

This evaluation makes use of federal information on staffing reported weekly by services to the CDC’s Nationwide Healthcare Security Community (NHSN) and displays information from mid-Might 2020 by February 27, 2022. These information are up to date repeatedly to replicate revised information from earlier weeks, so future variations of this dataset reflecting the identical time interval might output totally different values.

Every week, roughly 15,200 nursing services submit information by NHSN, together with whether or not they’re experiencing a scarcity in nursing workers (together with registered nurses, licensed sensible nurses, and vocational nurses), scientific workers (together with physicians, doctor assistants, and superior follow nurses), aides (together with licensed nursing assistants, nurse aides, treatment aides, and medicine technicians), or different workers (together with administrative, custodial, and different environmental service workers).  These measures are requested and reported as binary measures (sure/no) and replicate staffing shortages as of the week of knowledge reporting; subsequently, we’re unable to find out the magnitude of staffing shortages amongst nursing services that report “sure” to a number of workers positions. Moreover, these measures differ from different measures of staffing sufficiency, together with the minimal staffing ranges required by the federal authorities and states.

CMS performs information high quality checks to establish services which will have entered incorrect information earlier than publishing this information for public obtain. Services which have submitted misguided information may have an “N” displayed within the column titled “Handed High quality Assurance Examine”. Our last pattern of nursing services on this evaluation excludes services that CMS flagged of their information high quality verify, in addition to services which might be lacking scarcity measures. With these exclusions, every week of knowledge in Determine 1 represents anyplace from 14,100 to fifteen,100 services. Every week of knowledge represents a barely totally different set of services attributable to weekly variation in nursing facility reporting. The latest week of knowledge, as of February 27th, 2022, contains 14,126 nursing services. The federal information contains solely information on Medicare or Medicaid licensed nursing services. This evaluation subsequently doesn’t replicate different long-term care settings, resembling assisted dwelling services, residential care services, group houses, or intermediate care services.


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