Health Affairs Study Clashes with Previous Reports on Nursing Home Shortages

Health Affairs Study Clashes with Previous Reports on Nursing Home Shortages


Public policy journal Health Affairs this month reported a modest decline in nursing home staffing levels for the majority of 2020, rather than a drastic shortage in staff suggested by various news reports over the course of the year.

Taking data from the Centers for Medicare and Medicaid Services Payroll Based Journal (PBJ) system, Health Affairs found that there was no meaningful decline in staffing during the first nine months of the pandemic — in fact, there was a slight increase in staff hours per resident day to make up for the loss of family caregivers during visitor bans and daily activities.

A lack of these resources put pressure on nursing home staff to fill that void, Health Affairs said.

“Without visits from caregivers, nursing home staff were forced to fill in these activities, adding tasks to their already stretched days. In addition, it is possible that although the number of hours worked remained stable, there were fewer staff members working those hours, resulting in the perception of increased shortages and burnout,” the report noted.

The journal’s study took the microscope to 14,554 nursing homes across the nation, adding that the nursing home census decreased more than 10 percent, or an average of 77 residents in September compared to 86 in January.

Nurse staff hours per resident day showed a slight increase of nearly 6 minutes per resident for registered nurses, licensed practical nurses and certified nursing assistants; that’s for contract staffing too, Health Affairs said.

By comparison, prior national research said 15 to 20 percent of nursing homes reported a staff shortage. These are self-reported numbers, Health Affairs said, and “are prone to error and bias.”

“How can we reconcile these discrepant reports? First, nursing homes may be struggling to keep their facilities staffed and also succeeding at doing so,” the report explained.

An increased reliance on contractors during the pandemic and a change in policy surrounding competency requirements helped alleviate the potential for a widening gap in staffing, but that was in constant conflict with high turnover and a more demanding work day.

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