computer rendered illustration of a microscopic virus

Provider and policy action is needed to counter the effects of staff absences and departures, particularly during infectious disease outbreaks such as COVID-19, that may put nursing home residents at risk, according to the authors of a study published Friday in the journal JAMA Health Forum.

“Considerable staffing challenges suggest a potential need for policy action to ensure adequate staffing levels during nursing home outbreaks to protect resident health,” wrote authors Karen Shen, PhD; Brian E. McGarry, PT, PhD; David C. Grabowski, PhD; et al.

The researchers studied 2,967 nursing homes in 2020 and found that statistically significant declines in staffing levels occurred during severe COVID-19 outbreaks that didn’t resolve, on average, for 16 weeks after an outbreak’s start. 

“Facilities temporarily increased hiring, contract staff, and overtime to bolster staffing during outbreaks, but these measures did not fully replace lost staff, particularly certified nursing assistants,” the researchers wrote.

The authors concluded that policy action is needed at multiple levels to address staffing issues during infectious disease outbreaks, starting at the facility level.

Providers should put emergency staffing plans in place to address public health emergency situations before they arise, “such as centralized ‘strike teams’ that can be temporarily deployed,” they recommended. Federal and state governments can help facilitate those strike teams by providing supplemental staffing to facilities experiencing severe outbreaks, the authors added. The American Rescue Plan Act of 2021 provided temporary funding for this type of effort, which they said was helpful in addressing emergency staff shortages for a time. 

“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,” the authors wrote.

“Finally, policy makers should question whether traditional staffing measures accurately capture the adequacy of staffing levels during a pandemic or if new measures are needed,” they concluded.