Nursing homes across the U.S. are experiencing severe staffing shortages in poor areas where the need is likely to be greatest, researchers say.
This study – recently published in Journal of the American Geriatrics Society – examines staffing prior to the COVID-19 pandemic. A shortage of skilled clinical staff such as registered nurses (RNs) and physical therapists in nursing homes in poorer communities could put residents’ safety at risk, the study found. These communities are more likely to serve disadvantaged groups, including racial and ethnic minorities.
That alone won’t solve the problem, says senior author Jasmine Travers, an assistant professor at NYU’s Rory Meyers School of Nursing.
“We have to address and invest in the communities where these nursing homes are located,” she said.
This study aims to extend existing research on a factor of deprivation, poverty. Instead, the researchers used a measure of disadvantage in income, education, employment and housing, the Regional Deprivation Index. Instead of counties or zip codes, they focused on smaller areas called census tracts, each representing 600 to 3,000 residents.
“In earlier research, as we have done during the pandemic, we found that nursing home residents located in severely deprived neighborhoods had poor quality of care Bad,” Travers said. So, she said, the researchers realized that other differences might be contributing to the problem.
For this study, researchers mapped Regional Deprivation Index scores of more than 12,600 nursing homes, about 16 percent of which are located in severely disadvantaged communities. They analyzed nursing home quality and wage-based staffing data.
The analysis found significant differences in staffing among different communities.
For example, there are about 38% fewer physical and occupational therapists in severely deprived areas compared to wealthier areas. They also had about 30% fewer registered nurses and 5% fewer registered nurse assistants.
Reduced training to provide more skilled care.
In a 100-bed facility in a severely disadvantaged community, RNs provided approximately 5.6 hours less care per day, for example, compared to more favorable compared to community facilities.
Nursing homes in severely deprived areas tend to be for-profit, and they serve more black people and Medicaid recipients, surveys show.
In nursing homes with lower staffing levels, patient outcomes tend to be worse. That could include more falls, more use of antipsychotic and anti-anxiety medications, and more bedsores, Travers said.
Having more skilled staff can also directly impact care. For example, the higher the ratio of registered nurses to nurse practitioners, the lower the infection and death rates, the study noted.
“I do think the quality of care in nursing homes and other long-term care facilities is affected across the board,” global policy think tank RAND Corporation Society said Regina Shih, director of the Behavioral Policy Program.
Shih reviewed the findings, which he said could include insufficient coverage of the kinds of care RNs might provide. People in other roles may not be able to provide.
Nationwide, more than 1.4 million people live in approximately 15,500 Medicare- and Medicaid-certified nursing homes, according to the U.S. Data with the Department of Human Services.
Despite minimum staffing standards, recruiting and retaining employees can be more challenging because workers may not want to, Travers said Live in areas with poor housing, education and transportation.
Trickle down on nursing homes in terms of hiring,” she said.
One solution is to increase U.S. Centers for Medicare and Medicaid Services, so nursing homes can increase their wages. Travers said they should be required to use any additional funds to staff.
She added that addressing leadership issues and improving the home environment will make them a better place to work. And efforts to retain workers, such as rewards and sign-on bonuses, should also be considered.
Maintain and understand that competition has increased, especially now that with COVID, people are able to virtually and Remote work, without having to come in as often, and other jobs that are more desirable because they have better benefits,” Travers said. Registered nurses typically earn more in emergency rooms than in nursing homes, she noted.
Shih says one solution to retaining skilled nurses is to increase recognition for the hard work they do. There are other ways to boost job satisfaction beyond pay raises and other financial incentives, she said.
For example, may include giving nurses a role in governing programs and arrangements or providing childcare benefits.
“I think a lot of paramedics want a career path, if you can understand the career ladder and get certification programs and skills development coaching, which is also Helps retain nurses,” Shi said.
More information:
The White House has more information on providing quality care in nursing homes.
Jason R. Falvey et al., Severe Neighborhood Deprivation and Nursing Home Staffing in the United States, Journal of the American Geriatrics Association (2022). DOI: 10.1111/jgs.17990
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Citation : U.S. Nursing Homes Are Understaffed, While Minority Communities Are Worst (2022, Aug. 15) Retrieved Aug. 17, 2022, from https://medicalxpress.com/news/2022 -08-nursing-homes-understaffed-minority-worst.html
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