Allowing nursing home staff experiencing mild Covid symptoms to work, masked, appears to be better for resident welfare than furloughing infected workers.

Missing tasks outweighed increased harm from Covid transmission in a simulated scenario, according to a study published Monday morning in JAMA Network Open. Understaffing was associated with missed tasks, resident hospitalizations and deaths, costing an estimated $1.07 million per 100-bed facility; an additional $247,090 was missed with furloughed staff, based on data collected from the Centers for Medicare & Medicaid Services (CMS).

Allowing 75% of nursing home staff who were mildly ill with Covid to work averted most of these harms, the study found. About $85,470 was saved without worsening staff or resident Covid hospitalizations as well.

The modeling study was a simulation of a 100-bed nursing home, meant to dive into staff Covid furlough policies, ultimately finding that allowing staff to work with mild symptoms saved substantial direct medical and societal costs.

“In the current climate of extreme nursing home understaffing, allowing those with mild COVID-19 illness to work may prevent more harm from staffing shortages and missed care tasks, ultimately saving substantial costs,” authors said in the study.

Pervasive staffing shortages limit basic care needs in nursing homes currently, they said, and the simulation resulted in an annual 22.1% deficiency rate in care tasks at current average staffing levels.

Simulations suggest a mandatory staff furlough for Covid illness may have exacerbated current understaffing with missed care tasks, according to the study, and was associated with additional non-Covid-related hospitalizations – and potentially an additional death per year, when looking at a 100-bed facility.

“In contrast, if staff with mild [Covid] illness worked while masked, 73% of those missed care tasks could be completed with the tradeoff of a small number of additional [Covid] illnesses with minimal [Covid]–related hospitalizations for either staff or residents,” authors said.

Regulations to furlough staff with Covid was an early pandemic precaution, they said, when the frequency, severity and long-term effects were much greater. Now, vaccination and prior illness have reduced severe outcomes. This likely tipped the balance between the benefits of a mandatory furlough and unintended consequences on resident care, the study found.

Staff burnout was likely made worse with the mandatory furlough.

“All of this is not to say that nursing home employees should be encouraged to work while sick with a contagious pathogen. Rather, our work underscored the reality that the development of appropriate nursing home staffing policies involves tradeoffs,” authors noted in the study.

Simulation studies like this one published in JAMA can help assess such tradeoffs, they added. Vaccines, a general acceptance of masks in the workplace, and Covid strain adaptations all are factors that mitigate harm from Covid exposure compared to worse harm as a result of mandatory staff furloughs tied to Covid.

“This study constitutes an important example of how infection-control decision-making should account for broader and downstream impacts throughout a system and how systems approaches can elucidate these impacts,” the study authors said.

Of course, substantially increasing nursing home staff would allow for greater leeway to create furlough strategies and control pathogen spread, the study found, briefly referencing upcoming federal minimum staffing standards.