Coronavirus: Nursing Home Study Finds Alarming Shortages of Staff and PPE

By Christopher Cheney

During the coronavirus pandemic, many nursing homes have struggled with shortages of staff and personal protective equipment (PPE), a new research article shows.

Through July, nearly half of the country’s COVID-19 deaths had occurred in nursing homes or other long-term care facilities, with 60,000 deaths. The virus also has taken a heavy toll on long-term care healthcare workers, with 760 deaths through July.

“Many nursing homes in the United States are poorly prepared to prevent and manage COVID-19 outbreaks, given a lack of essential PPE and staff. Despite intense policy attention and mounting mortality, the shortages did not meaningfully improve from May to July 2020,” says the new research article, which was published today by Health Affairs.

The study features information gathered from more than 15,000 nursing homes. The research includes several key data points:

  • At the end of the study in July, 19.1% of nursing homes reported severe shortages of PPE, particularly N95 respirator masks and gowns.
  • At the end of the study, 21.9% of nursing homes reported staff shortages.
  • Nurse aids led staff shortages at 18.5%, followed by nurses at 16.0% and other staff at 9.3%
  • Nursing homes with the highest star ratings from the Centers for Medicare & Medicaid Services (CMS) were less likely to report staffing shortages. Compared to nursing homes with a one-star overall rating, five-star nursing homes were 6.4 percentage points to 7.5 percentage points less likely to report staffing shortages.
  • PPE shortages were nationwide, with dire shortfalls in northern New England, Alabama, North Carolina, Tennessee, and West Virginia.
  • Staff shortages were concentrated in the South and Midwest, particularly Alabama, Eastern Texas, Georgia, and Louisiana.

“Using the most comprehensive survey of nursing homes during the COVID-19 pandemic to date, we found that roughly one in five facilities faced a staff shortage or a severe shortage of PPE in early July 2020. Despite a slight decrease in facilities with any PPE shortage driven by the higher availability of gowns, overall PPE and staff shortages had not meaningfully improved since late May 2020,” the research article’s co-authors wrote.

Interpreting the data

Since the beginning of the pandemic, nursing homes have established good protocols for infection control, visitation, quarantine procedures, and testing. But resources remain a concern, the lead author of the research article told HealthLeaders.

“Our study looked at two fundamental resources, PPE and staffing, and found that about 20% of facilities reported each type of shortage. This obviously raises significant concerns that a lack of adequate PPE or a workforce spread too thin will be the weak points in managing COVID-19 patients and preventing outbreaks as we head into fall and winter and future COVID-19 outbreaks,” said Brian McGarry, PhD, an assistant professor in the Department of Medicine at University of Rochester in Rochester, New York.

Specific types of nursing homes are at highest risk of PPE and staff shortages, he said.

“With respect to PPE shortages, we found that for-profit, chain-affiliated, and lower quality—as measured by the CMS 5-star quality score)—were more likely to report shortages. Facilities that reported having had COVID-19 cases among their residents and staff were also more likely to report a PPE shortage,” McGarry said.

“In terms of staff shortages, these were more common among facilities that are government owned, have greater shares of revenue from Medicaid, and lower quality facilities, in terms of both the overall quality score and a staffing-specific quality score. Additionally, having had COVID-19 cases among staff was also associated with an increased likelihood of reporting a staff shortage,” he said.

The findings indicate a pattern, McGarry said. “Disadvantaged facilities—those with lower quality and those that disproportionately serve residents with safety-net Medicaid coverage—were more likely to report shortages. These facilities may be more financially constrained and may have difficulty buying additional PPE stocks or hiring additional staff.”

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.