Significant NH Staffing Disparities Observed in Severely Deprived US Neighborhoods

Nursing home (NH) facilities located in severely deprived neighborhoods in the United States experienced significant staffing disparities, according to findings published in Journal of the American Geriatrics Society.

Study authors conducted a cross-sectional study of 2018 daily payroll-based staffing records and address data for 12,609 US NHs linked with resident assessment data to determine the association between socioeconomic deprivation and staffing rates.

Severe economic deprivation at the census block group level was defined as an area deprivation index score ≥85/100. Hours worked per resident-day among NH employees providing direct resident care was the primary outcome.

Unadjusted staffing rates in facilities located within severely deprived neighborhoods were 38% lower for physical and occupational therapists, 30% lower for registered nurses (RNs), and 5% lower for certified nursing assistants when compared to less deprived neighborhoods.

Researchers observed no disparities in licensed practical nurse (LPN) staffing.

A similar patten of disparities was observed in models with state-level and rurality fixed effects clustered on the county.

“Specifically, RN staffing per 100 resident-days was significantly lower in facilities located within severely deprived neighborhoods as compared to those in less deprived areas (mean difference: 5.6 fewer hours, 95% confidence interval [CI] 4.2-6.9),” wrote researchers.

Results showed disparities of lower magnitude for other clinical disciplines except for LPNs.

“Targeted interventions, including workforce recruitment and retention efforts, may be needed to improve staffing levels for nursing homes in deprived neighborhoods,” concluded study authors.

Reference:
Falvey JR, Hade EM, Friedman S, et al. Severe neighborhood deprivation and nursing home staffing in the United States. J Am Geriatr Soc. Published online August 8, 2022. doi:10.1111/jgs.17990