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- Title
Examination of Staffing Shortages at US Nursing Homes During the COVID-19 Pandemic.
- Authors
Brazier, Joan F.; Geng, Fangli; Meehan, Amy; White, Elizabeth M.; McGarry, Brian E.; Shield, Renee R.; Grabowski, David C.; Rahman, Momotazur; Santostefano, Christopher; Gadbois, Emily A.
- Abstract
Key Points: Question: Do nursing home administrator perspectives on staffing in US nursing homes during the COVID-19 pandemic provide context for conflicting staffing data reports? Findings: In this study, qualitative and quantitative data from 40 US nursing homes were integrated to assess staffing levels during the pandemic. Short-term compensatory strategies were used by administrators to comply with minimum staffing regulations and offset staffing shortages. Meaning: Findings from this study suggest that staffing shortages during the COVID-19 pandemic placed strain on nursing homes. Importance: Staffing shortages have been widely reported in US nursing homes during the COVID-19 pandemic, but traditional quantitative research analyses have found mixed evidence of staffing shortfalls. Objective: To examine whether nursing home administrator perspectives can provide context for conflicting aggregate staffing reports in US nursing homes during the COVID-19 pandemic. Design, Setting, and Participants: In a qualitative study, convergent mixed-methods analysis integrating qualitative and quantitative data sets was used. Semistructured qualitative interviews were conducted between July 14, 2020, and December 16, 2021. Publicly available national Payroll Based Journal data were retrieved from January 1, 2020, to September 30, 2022, on 40 US nursing homes in 8 health care markets that varied by region and nursing home use patterns. Staffing and resident measures were derived from Payroll Based Journal data and compared with national trends for 15 436 US nursing homes. Nursing home administrators were recruited for interviews. Of the 40 administrators who consented to participate, 4 were lost to follow-up. Exposure: Four repeated, semistructured qualitative interviews with participants were conducted. Interview questions focused on the changes noted during the COVID-19 pandemic in nursing homes. Main Outcomes and Measures: Thematic description of nursing home administrator compensatory strategies to provide context for quantitative analyses on nursing home staffing levels during the COVID-19 pandemic. Results: A total of 156 interviews were completed with 40 nursing home administrators. Administrators reported experiencing staff shortages during the COVID-19 pandemic and using compensatory strategies, such as overtime, cross-training, staff-to-resident ratio adjustments, use of agency staff, and curtailing admissions, to maintain operations and comply with minimum staffing regulations. Payroll Based Journal data measures graphed from January 1, 2020, to September 30, 2022, supported administrator reports showing that study facilities had reductions in staff hours, increased use of agency staff, and decreased resident census. Findings were similar to national trends. Conclusions and Relevance: In this qualitative, convergent mixed-methods study, nursing home administrators reported the major staffing strain they experienced at their facilities and the strategies they used to offset staffing shortages. Their experiences provide context to quantitative analyses on aggregate nursing home census data. The short-term compensatory measures administrators used to comply with regulations and maintain operations may be detrimental to the long-term stability of this workforce. This qualitative study examines the strategies used by nursing home administrators to cope with changes in staffing during the COVID-19 pandemic.
- Subjects
UNITED States; HEALTH services administrators; PSYCHOLOGICAL burnout; NURSING care facility administration; HEALTH services administration; ATTITUDES of medical personnel; WORK; HEALTH facility administration; RESEARCH methodology; SELF-evaluation; QUALITY of work life; GROUNDED theory; GOVERNMENT regulation; LABOR demand; INTERVIEWING; REGULATORY approval; MEDICAL registry personnel; EXPERIENTIAL learning; RESEARCH funding; EMPLOYEES' workload; SOUND recordings; DATA analysis software; THEMATIC analysis; INTERDISCIPLINARY education; JUDGMENT sampling; COVID-19 pandemic
- Publication
JAMA Network Open, 2023, Vol 6, Issue 7, pe2325993
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.25993