At Least 1 in 5 Nursing Homes Report ‘Severe Shortage’ of Staff and PPE, with No Progress Since May

More than one in five nursing homes reported “severe” shortfalls of both personal protective equipment (PPE) and staffing, a new study published in the journal Health Affairs found — and those shortages did not meaningfully improve from May to July.

The study is scheduled for publication in a later print edition of the journal, with an advance version posted online on August 20.

“Using the most comprehensive survey of nursing homes during the COVID-19 pandemic to date, we found that over 1 in 5 facilities faced a staff shortage or severe shortage of PPE in early July 2020,” the authors — Brian McGarry of the University of Rochester and David Grabowski and Michael Barnett of Harvard University — wrote. “Despite a slight decrease in facilities with any PPE shortage driven by higher availability of gowns, overall PPE and staff shortages have not meaningfully improved since late May 2020.”

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The authors drew from the Centers for Medicare & Medicaid Services’ (CMS) COVID-19 Nursing Home Database, using two four-week reporting periods: May 18 through June 24, and June 24 through July 19. The primary study sample included Medicare- and Medicaid-certified nursing homes that submitted responses to staffing and PPE questions during at least one of the weekly reporting periods during the two study windows; the authors also studied all such nursing homes to compare facilities with and without submitted data.

Overall, the authors identified 15,388 nursing homes in the data, with 15,035 submitting sufficient staff and PPE data.

During the first study window, 20.7% of nursing homes with submitted data reported a week or less of available supplies of PPE; 13.4% of nursing homes reported shortages of N95 masks, while 12.6% indicated a shortage of gowns. Meanwhile, 20.8% of facilities reported a shortage of staff, with 17.2% reporting a shortage of nursing aides.

At the end of the second study window in July, 19.1% of nursing homes reported shortages of PPE, while 21.9% reported shortages of staff. Once again, N95 masks and gowns were the most common shortages.

PPE emerged early in the pandemic as one of the most difficult challenges for nursing homes as prices soared and the amount SNFs needed skyrocketed. But the authors did find some predictors of shortages during the two study windows:

  • Government ownership
  • Having greater shares of Medicaid revenue
  • Having COVID cases among staff

They also found that facilities with a higher rating on general quality scores — and better records of previous staffing levels — were less likely to report a shortage.

“For-profit nursing homes reported substantially higher rates of PPE shortages than other facilities, but not staffing shortages,” the authors wrote. “This is especially concerning given that the vast majority of nursing homes in the US are for-profit and a substantial literature from before the pandemic documenting lower quality of care at for-profit nursing homes compared to non-profit facilities.”

Geography showed widespread variations on both PPE and staffing shortages, with “clusters of high shortage rates” of PPE in northern New England, Iowa, Alabama, North Carolina, West Virginia and Tennessee. High staff shortage rates were concentrated in some parts of the South and Midwest.

But SNFs across the country reported shortages of both, and there are some specific policy implications from the study — even though the authors noted that the most effective way of containing COVID-19 outbreaks was to reduce community prevalence.

“First, too many nursing homes lack a minimally sufficient supply of PPE to adequately protect themselves from COVID-19,” they wrote. “This shortage has now persisted over a period of almost two months. Given that nearly half of all deaths from COVID-19 in the US come from nursing home residents, this must be a policy priority if policymakers intend to save as many lives as possible.”

Given that the most vulnerable nursing homes are at the highest risk, additional targeted financial support — combined with oversight to ensure that the funds are used as intended — would help address some of the many financial challenges stemming from the pandemic for nursing homes, the researchers concluded.

“Many nursing homes in the US are poorly prepared to prevent and manage COVID-19 outbreaks given a lack of essential PPE and staff,” the authors wrote. “Despite intense policy attention and mounting mortality, the shortages have not meaningfully improved from May to July of 2020. Unless these shortages are prioritized by policymakers, long-term care residents will continue to be at a great disadvantage in the pandemic.”

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