Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
Division of Geriatrics & Aging, Department of Medicine, University of Rochester Medical Center, Rochester, New York.
JAMA Health Forum. 2022 Jul 22;3(7):e222151. doi: 10.1001/jamahealthforum.2022.2151. eCollection 2022 Jul.
Staff absences and departures at nursing homes may put residents at risk and present operational challenges.
To quantify changes in nursing home facility staffing during and after a severe COVID-19 outbreak.
In this cohort study, daily staffing payroll data were used to construct weekly measures of facility staffing, absences, departures, and use of overtime and contract staff among US nursing homes experiencing a severe COVID-19 outbreak that started between June 14, 2020, and January 1, 2021. Facility outbreaks were identified using COVID-19 case data. An event-study design with facility and week fixed effects was used to investigate the association of severe outbreaks with staffing measures.
Weeks since the beginning of a severe COVID-19 outbreak (4 weeks prior to 16 weeks after).
Total weekly staffing hours, staff counts, staff absences, departures, new hires, overtime and contract staff hours measured for all nursing staff and separately by staff type (registered nurses, licensed practical nurses, certified nursing assistants), facility self-reported staff shortages, and resident deaths.
Of the included 2967 nursing homes experiencing severe COVID-19 outbreaks, severe outbreaks were associated with a statistically significant drop in nursing staffing levels owing to elevated absences and departures. Four weeks after an outbreak's start, around when average new cases peaked, staffing hours were 2.6% (95% CI, 2.1%-3.2%) of the mean below preoutbreak levels, despite facilities taking substantial measures to bolster staffing through increased hiring and the use of contract staff and overtime. Because these measures were mostly temporary, staffing declined further in later weeks; 16 weeks after an outbreak's start, staffing hours were 5.5% (95% CI, 4.5%-6.5%) of the mean below preoutbreak levels. Staffing declines were greatest among certified nursing assistants, primarily owing to smaller increases in new hires of this staff type compared with licensed practical nurses and registered nurses.
In this cohort study of nursing homes experiencing severe COVID-19 outbreaks, facilities experienced considerable staffing challenges during and after outbreaks. These results suggest the need for policy action to ensure facilities' abilities to maintain adequate staffing levels during and after infectious disease outbreaks.
疗养院员工缺勤和离职可能会使居民面临风险，并带来运营挑战。
量化 COVID-19 严重爆发期间和之后疗养院设施人员配备的变化。
设计、地点和参与者：在这项队列研究中，使用每日人员配备工资单数据构建了每周设施人员配备、缺勤、离职、加班和合同工使用的措施，这些数据来自于经历严重 COVID-19 爆发的美国疗养院，爆发始于 2020 年 6 月 14 日至 2021 年 1 月 1 日之间。使用 COVID-19 病例数据确定设施爆发。使用设施和周固定效应的事件研究设计来研究严重爆发与人员配备措施的关联。
严重 COVID-19 爆发开始后的周数（爆发前 4 周至爆发后 16 周）。
所有护理人员的每周总工作时间、员工人数、员工缺勤、离职、新员工、加班和合同工时间，以及按员工类型（注册护士、执业护士、注册助理护士）、设施自我报告的人员短缺和居民死亡情况进行测量。
在所纳入的 2967 家经历严重 COVID-19 爆发的疗养院中，由于缺勤和离职率升高，严重爆发与护理人员配备水平的显著下降有关。在爆发开始后的四周，即平均新病例达到峰值时，尽管设施通过增加招聘和使用合同工和加班来大力加强人员配备，但工作时间比爆发前的平均水平低 2.6%（95%CI，2.1%-3.2%）。由于这些措施大多是临时性的，因此在后续几周内人员配备进一步下降；在爆发开始后的 16 周，工作时间比爆发前的平均水平低 5.5%（95%CI，4.5%-6.5%）。助理护士的人员配备降幅最大，主要是因为与执业护士和注册护士相比，这类员工的新员工人数增加较少。
在这项经历严重 COVID-19 爆发的疗养院队列研究中，设施在爆发期间和之后都面临着相当大的人员配备挑战。这些结果表明，需要采取政策行动，确保设施在传染病爆发期间和之后保持足够的人员配备水平的能力。
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