Human Development and Family Studies, The Pennsylvania State University, State College, PA, USA.
Department of Psychology, Clemson University, Clemson, SC, USA.
Policy Polit Nurs Pract. 2024 Aug;25(3):152-161. doi: 10.1177/15271544241270061. Epub 2024 Aug 16.
Research to assess and inform health policy is an essential component of the policymaking process to advance equity in public health practice. This study investigated health disparities during the COVID-19 pandemic (2020-2022) in older adult institutional settings in Philadelphia, PA, to inform policy initiatives, interventions, and infrastructure development. We first explored the changing patterns of nursing staffing levels (total direct care staff and registered nurses [RNs]) measured by hours per resident per day (HPRD) before and after COVID-19. Our findings revealed that HPRD levels consistently fell below the Centers for Medicare and Medicaid Services recommended standards from 2018 to 2022, with notable declines observed starting from 2021. Results from multilevel modeling showed significant declines in HPRD for total direct care nursing staff in nursing homes located in zip codes with a high proportion of Black residents (≥40%). In contrast, HPRD for RNs significantly declined in nursing homes located in zip codes with a lower proportion of Black residents (<40%). Moreover, higher reported direct care HPRD and RN HPRD were associated with any reported COVID-19 cases only within zip codes with a low proportion of Black residents. These findings indicate the need for additional policies to address these observed patterns in staffing levels. Our study provides a foundation for future policy reviews utilizing a conceptual framework that is health equity-centric for local and state health departments program and units intended for institutional care settings for older adults.
研究旨在评估和为卫生政策提供信息，是推进公共卫生实践公平性的决策过程的重要组成部分。本研究调查了宾夕法尼亚州费城老年机构在 COVID-19 大流行期间（2020-2022 年）的健康差距，以为政策倡议、干预措施和基础设施发展提供信息。我们首先探讨了护理人员配置水平（总直接护理人员和注册护士 [RN]）在 COVID-19 前后按每居民每天小时（HPRD）测量的变化模式。我们的研究结果表明，从 2018 年到 2022 年，HPRD 水平始终低于医疗保险和医疗补助服务中心推荐的标准，从 2021 年开始明显下降。多层次模型的结果显示，黑人员工比例较高（≥40%）的邮政编码中，养老院的总直接护理护理人员的 HPRD 显著下降。相比之下，黑人员工比例较低（<40%）的邮政编码中，RN 的 HPRD 显著下降。此外，报告的直接护理 HPRD 和 RN HPRD 较高仅与黑人员工比例较低的邮政编码内的任何报告的 COVID-19 病例有关。这些发现表明需要采取额外的政策来解决这些人员配置水平的观察模式。我们的研究为未来的政策审查提供了基础，利用了一个以健康公平为中心的概念框架，为当地和州卫生部门的机构护理老年人的计划和单位提供了基础。
