Higher Number of Unique Staff Members Linked to COVID-19 Cases, Deaths in SNFs

Staff size was linked with number of COVID-19 cases and deaths in skilled nursing facilities (SNFs) in 2020, according to new research findings published in Health Affairs.

The retrospective cohort study was conducted using data from June 1 to September 27, 2020. The primary sample was 7154 CMS-certified SNFs whose residents had no COVID-19 cases as of the week ending June 7. Staff size was correlated with facility size, with an average of 27.1 employees per day in the lowest staff size quartile and 101.2 employees per day in the highest quartile.

SNFs with the highest staff size quartile had 92% more cases than those with the lowest, with 11.9 resident cases per 100 beds (95% confidence interval [CI]: 10.1, 13.6) compared with 6.2 cases per 100 beds (95% CI: 5.2, 7.2). The fourth quartile also experienced 11.8 staff cases per 100 beds (95% CI: 10.6, 13.1) in comparison to 7.0 staff cases per 100 beds (95% CI: 6.2, 7.8) in the first quartile.

Additionally, SNFs in the fourth quartile experienced 133% more resident deaths than those in the first quartile, with 2.1 (95% CI: 1.7, 2.5) and 0.9 (95% CI: 0.7, 1.2) resident deaths per 100 beds, respectively.

“Supplemental analyses indicated that numbers of direct care employees and other employees, but not therapy employees, were associated with COVID-19 cases and deaths,” researchers wrote. “Direct care staff sizes were more strongly associated with case rates in comparison with other staff.”

Researchers gathered data on COVID-19 outcomes during the study period using the Centers for Medicare and Medicaid Services (CMS) Nursing Home COVID-19 Public File. Data included weekly reporting by SNFs on COVID-19 cases and deaths for both staff and residents. Staff sizes were calculated using records from CMS’s Payroll Based Journal electronic staffing reporting system in the fourth quarter of 2019 and did not reflect changes caused by outbreaks.

The authors recommended changes to the number of unique staff entering SNFs, such as moving nonessential work to remote locations and opting for full-time staff hours over part-time.

“Our findings do not imply that nursing homes should have lower staffing ratios per resident,” study authors noted. “Rather, our findings suggest that when facilities with the same staffing ratios are being compared, nursing homes that can provide those staff hours with fewer unique staff members will be better able to protect their residents from COVID-19.”

Reference:
McGarry BE, Gandhi AD, Grabowski DC, Barnett ML. Larger nursing home staff size linked to higher number of COVID-19 cases in 2020 [published online ahead of print July 14, 2021]. Health Aff. 2021. doi:10.1377/hlthaff.2021.00323