As of mid-January 2021, there have been 444,389 COVID-19 cases reported among nursing home staff nationwide, resulting in 1,313 deaths. A major contribution to staff contracting COVID-19 is the lack of personal protective equipment (PPE). Research by U.S. PIRG (Public Interest Research Group) Education Fund and Frontier Group shows shortages of most types of PPE decreased significantly during the fall months but increased once again during December 2020.
Staff shortages also increased significantly from May to December 2020:
- A shortage of certified nursing assistants (CNAs) was the most widespread problem, affecting 20.6 percent of nursing homes in December, up from 17.4% in May 2020.
- A shortage of nurses affected 18.5% of nursing homes in December 2020, up from 15% in May.
- The reported number of nursing homes with a shortage in at least one staffing category increased to 3,136 in December, up from 2,790 in May. The percentage of nursing homes with a shortage of at least one category of staff was 19.9% in May, rising to 22.8% in December.
University of Chicago research shows that nursing homes with one or more COVID-19 cases were likely to have fewer deaths and a lower probability of a severe outbreak if they had higher levels of staffing before the pandemic. The research shows that staff shortages contributed to the spread of COVID-19 in many of the nursing homes, and more staff means it is easier for a nursing home to adopt best practices, such as regular testing of residents and staff and separating residents by COVID-19 status.
The pandemic made the existing problem of staffing shortages worse in the following ways:
- Workers had to stay home if they were sick with COVID.
- Workers quit their jobs or took a leave of absence to care for young children whose schools or daycare centers suddenly were shut down.
- Workers took time off or quit to care for family members who contracted COVID.
- Widespread testing after CMS started requiring regular staff testing in July meant asymptomatic COVID-19 cases among workers were identified, requiring them to take time off to reduce COVID spread, but also reducing staffing levels.
- In spring and summer 2020, the worst outbreaks were confined to certain regions of the country. By the end of 2020 and since, surges have been geographically widespread, making it harder for providers to recruit staff from geographic areas with lower infection rates since most areas are experiencing this surge in cases at the same time.
- As the pandemic persisted, more workers found jobs that paid more and brought less risk.
Barriers to adequate staffing have made the problem urgent.
Issue
Keeping staff and residents safe should always be the priority in every nursing facility. Adequate staffing and supply of PPE should be prioritized daily. Failure to provide PPE to healthcare workers battling COVID-19 on the front lines can be devastating for both staff and residents. Ramifications of inadequate staffing can be dire.
Discussion:
- Review policies and procedures for ordering and maintaining an adequate supply of PPE. Ensure that policies address alternate staffing options should critical shortages occur. Review your Emergency Preparedness Plan for inclusion of these topics, and update if needed.
- Provide education to all staff on the Emergency Preparedness Plan, with a focus on managing the use of PPE and emergency staffing options. Train the purchasing department to calculate the amount of PPE needed and to ensure it is available for staff.
- Periodically audit the supply of PPE available for staff, and monitor staffing levels to provide quality patient care.
MAINTAINING PROPER INFECTION CONTROL PROCEDURES
RECRUITING NEW EMPLOYEES – PAVING THE ROAD TO OBTAINING COMPETENT STAFF
