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Kim EJ, Park YH, Choi HR. Factors influencing nurses' compliance related to the use of personal protective equipment during the COVID-19 pandemic: A descriptive cross-sectional study. Nurs Open 2024; 11:e2235. [PMID: 38958036 DOI: 10.1002/nop2.2235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 06/11/2024] [Accepted: 06/21/2024] [Indexed: 07/04/2024] Open
Abstract
AIM To determine how nurses' experiences with the coronavirus disease (COVID-19) pandemic affected their knowledge, awareness, and compliance related to the use of personal protective equipment (PPE) during the COVID-19 pandemic in South Korea. DESIGN A descriptive cross-sectional study. METHODS A total of 247 nurses in South Korea participated in this study between May 10 and 19, 2023. An online self-report questionnaire was used to collect data on demographic and occupational characteristics, COVID-19 experience, knowledge, awareness, and compliance related to the use of PPE. Factors affecting compliance were analysed using hierarchical multiple linear regression. RESULTS Mean age of the nurses was 31.92, and 94.3% were women. Most had a bachelor's degree or higher and the mean clinical experience as a nurse was 6.45 years. Knowledge of the use of PPE was 8.45 out of 10, awareness was 3.52 out of 5, and compliance was 4.28 out of 5. Knowledge and awareness were correlated with compliance related to PPE use. Awareness (β = 0.234, p < 0.001), knowledge (β = 0.218, p < 0.001), experience caring for COVID-19 patients (β = 0.234, p = 0.004), optional fourth dose vaccine (β = 0.150, p = 0.017), clinical experience (β = 0.140, p = 0.022), and COVID-19 infection control education (β = 0.115, p = 0.037) were found to have a significant impact on compliance. CONCLUSION During the COVID-19 pandemic, nurses' knowledge and awareness of PPE use was a crucial factor in compliance. factors such as clinical experience, experience in caring for COVID-19 patients, optional vaccination, and completion of COVID-19 education also influenced compliance. We hope that these factors can provide a basis for developing training programs for nurses to respond to future emerging infectious diseases.
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Affiliation(s)
- Eun-Jin Kim
- Department of Nursing, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yeon-Hwan Park
- College of Nursing, The Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
| | - Hye-Ran Choi
- Department of Clinical Nursing, University of Ulsan, Seoul, Republic of Korea
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Konetzka RT, Grabowski DC, Mor V. Four Years And More Than 200,000 Deaths Later: Lessons Learned From The COVID-19 Pandemic In US Nursing Homes. Health Aff (Millwood) 2024; 43:985-993. [PMID: 38950293 DOI: 10.1377/hlthaff.2023.01460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Abstract
Nursing home residents and staff were disproportionately affected by the COVID-19 pandemic, drawing attention to long-standing challenges of poor infection control, understaffing, and substandard quality of care in many facilities. Evolving practices and policies during the pandemic often focused on these challenges, with little effect. Despite the emergence of best practices to mitigate transmission of the virus, even the highest-quality facilities experienced outbreaks, indicating a larger systemic problem, rather than a quality problem at the facility level. Here we present a narrative review and discussion of the evolution of policies and practices and their effectiveness, drawing on evidence from the United States that was published during 2020-23. The lessons learned from this experience point to the need for more fundamental and nuanced changes to avoid similar outcomes from a future pandemic: greater integration of long-term care into public health planning, and ultimately a shift in the physical structure of nursing homes. More incremental measures such as vaccination mandates, higher staffing, and balancing infection control with resident quality of life will avoid some adverse outcomes, but without more systemic change, nursing home residents and staff will remain at substantial risk for repetition of the poor outcomes from the COVID-19 pandemic.
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Affiliation(s)
| | | | - Vincent Mor
- Vincent Mor, Brown University, Providence, Rhode Island
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McGarry BE, Gandhi AD, Chughtai MA, Yin J, Barnett ML. Clinical Outcomes After Admission of Patients With COVID-19 to Skilled Nursing Facilities. JAMA Intern Med 2024; 184:799-808. [PMID: 38829646 PMCID: PMC11148790 DOI: 10.1001/jamainternmed.2024.1079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/20/2024] [Indexed: 06/05/2024]
Abstract
Importance During the COVID-19 pandemic, stabilized COVID-19-positive patients were discharged to skilled nursing facilities (SNFs) to alleviate hospital crowding. These discharges generated controversy due to fears of seeding outbreaks, but there is little empirical evidence to inform policy. Objective To assess the association between the admission to SNFs of COVID-19-positive patients and subsequent COVID-19 cases and death rates among residents. Design, Setting, and Participants This cohort study analyzed survey data from the National Healthcare Safety Network of the Centers for Disease Control and Prevention. The cohort included SNFs in the US from June 2020 to March 2021. Exposed facilities (ie, with initial admission of COVID-19-positive patients) were matched to control facilities (ie, without initial admission of COVID-19-positive patients) in the same county and with similar preadmission case counts. Data were analyzed from June 2023 to February 2024. Exposure The week of the first observable admission of COVID-19-positive patients (defined as those previously diagnosed with COVID-19 and continued to require transmission-based precautions) during the study period. Main Outcomes and Measures Weekly counts of new cases of COVID-19, COVID-19-related deaths, and all-cause deaths per 100 residents in the week prior to the initial admission. A stacked difference-in-differences approach was used to compare outcomes for 10 weeks before and 15 weeks after the first admission. Additional analyses examined whether outcomes differed in facilities with staff or personal protective equipment (PPE) shortages. Results A matched group of 264 exposed facilities and 518 control facilities was identified. Over the 15-week follow-up period, exposed SNFs had a cumulative increase of 6.94 (95% CI, 2.91-10.98) additional COVID-19 cases per 100 residents compared with control SNFs, a 31.3% increase compared with the sample mean (SD) of 22.2 (26.4). Exposed facilities experienced 2.31 (95% CI, 1.39-3.24) additional cumulative COVID-19-related deaths per 100 residents compared with control facilities, representing a 72.4% increase compared with the sample mean (SD) of 3.19 (5.5). Exposed facilities experiencing potential staff shortage and PPE shortage had larger increases in COVID-19 cases per 100 residents (additional 10.97 [95% CI, 2.76-19.19] cases and additional 14.81 [95% CI, 2.38-27.25] cases, respectively) compared with those without such shortages. Conclusion This cohort study suggests that admission of COVID-19-positive patients into SNFs early in the pandemic was associated with preventable COVID-19 cases and mortality among residents, particularly in facilities with potential staff and PPE shortages. The findings speak to the importance of equipping SNFs to adhere to infection-control best practices as they continue to face COVID-19 strains and other respiratory diseases.
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Affiliation(s)
- Brian E. McGarry
- Division of Geriatrics and Aging, Department of Medicine, University of Rochester, Rochester, New York
| | - Ashvin D. Gandhi
- Anderson School of Management, UCLA (University of California, Los Angeles)
| | - Mah Afroze Chughtai
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Jiamin Yin
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Michael L. Barnett
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
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Brazier JF, White EM, Meehan A, Shield RR, Grabowski DC, Rahman M, Gadbois EA. Rethinking Infection Control: Nursing Home Administrator Experiences during the COVID-19 Pandemic. J Am Med Dir Assoc 2024; 25:105071. [PMID: 38852611 DOI: 10.1016/j.jamda.2024.105071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVE To examine nursing home administrator perspectives of infection control practices in nursing homes at the height of the COVID-19 pandemic and characterize lessons learned. DESIGN Descriptive qualitative study. SETTING AND PARTICIPANTS Administrators from 40 nursing homes across 8 diverse health care markets in the United States. METHODS Semistructured interviews were conducted via telephone or Zoom with nursing home administrators. Interviews were repeated at 3-month intervals, for a total of 4 interviews per participant between July 2020 and December 2021 (n = 156). Qualitative analysis of interview transcripts used modified grounded theory and thematic analysis to identify overarching themes. RESULTS Three major themes emerged reflecting administrator experiences managing infection control practices and nursing home operations at the height of the COVID-19 pandemic. First, administrators reported that the more stringent infection control protocols implemented to manage and mitigate COVID-19 at their facilities increased awareness and understanding of the importance of infection control; second, administrators reported incorporating higher standards of infection control practices into facility-level policies, emergency preparedness plans, and staff training; and third, administrators said they and their executive leadership were reevaluating and upgrading their facilities' physical structures and operational processes for better infection control infrastructure in preparation for future pandemics or other public health crises. CONCLUSIONS AND IMPLICATIONS Insights from this study's findings suggest important next steps for restructuring and improving nursing home infection control protocols and practices in preparation for future pandemics and public health emergencies. Nursing homes need comprehensive, standardized infection control training and upgrading of physical structures to improve ventilation and facilitate isolation practices when needed. Furthermore, nursing home emergency preparedness plans need better integration with local, state, and federal agencies to ensure effective communication, proper resource tracking and allocation, and coordinated, rapid response during future public health crises.
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Affiliation(s)
- Joan F Brazier
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA.
| | - Elizabeth M White
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Amy Meehan
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Renee R Shield
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Momotazur Rahman
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Emily A Gadbois
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
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Meehan A, Brazier JF, Grabowski DC, Rahman M, Shield RR, Gadbois EA. Administrator Perspectives on the Impact of COVID-19 on the Administration of the Patient Driven Payment Model in U.S. Skilled Nursing Facilities. Med Care Res Rev 2024; 81:223-232. [PMID: 38419595 DOI: 10.1177/10775587241233018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
The Patient Driven Payment Model (PDPM) was implemented in U.S. skilled nursing facilities (SNFs) in October 2019, shortly before COVID-19. This new payment model aimed to reimburse SNFs for patients' nursing needs rather than the previous model which reimbursed based on the volume of therapy received. Through 156 semi-structured interviews with 40 SNF administrators from July 2020 to December 2021, this qualitative study clarifies the impact of COVID-19 on the administration of PDPM at SNFs. Interview data were analyzed using modified grounded theory and thematic analysis. Our findings show that SNF administrators shifted focus from management of the PDPM to COVID-19-related delivery of care adaptations, staff shortfalls, and decreased admissions. As the pandemic abated, administrators re-focused their attention to PDPM. Policy makers should consider the continued impacts of the pandemic at SNFs, particularly on delivery of care, admissions, and staffing, on the ability of SNF administrators to administer a new payment model.
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Choi JY, Kim H, Chun S, Jung YI, Yoo S, Oh IH, Kim GS, Ko JY, Lim JY, Lee M, Lee J, Kim KI. Information technology-supported integrated health service for older adults in long-term care settings. BMC Med 2024; 22:212. [PMID: 38807210 PMCID: PMC11134747 DOI: 10.1186/s12916-024-03427-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/16/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND To examine the effectiveness and safety of a data sharing and comprehensive management platform for institutionalized older patients. METHODS We applied information technology-supported integrated health service platform to patients who live at long-term care hospitals (LTCHs) and nursing homes (NHs) with cluster randomized controlled study. We enrolled 555 patients aged 65 or older (461 from 7 LTCHs, 94 from 5 NHs). For the intervention group, a tablet-based platform comprising comprehensive geriatric assessment, disease management, potentially inappropriate medication (PIM) management, rehabilitation program, and screening for adverse events and warning alarms were provided for physicians or nurses. The control group was managed with usual care. Co-primary outcomes were (1) control rate of hypertension and diabetes, (2) medication adjustment (PIM prescription rate, proportion of polypharmacy), and (3) combination of potential quality-of-care problems (composite quality indicator) from the interRAI assessment system which assessed after 3-month of intervention. RESULTS We screened 1119 patients and included 555 patients (control; 289, intervention; 266) for analysis. Patients allocated to the intervention group had better cognitive function and took less medications and PIMs at baseline. The diabetes control rate (OR = 2.61, 95% CI 1.37-4.99, p = 0.0035), discontinuation of PIM (OR = 4.65, 95% CI 2.41-8.97, p < 0.0001), reduction of medication in patients with polypharmacy (OR = 1.98, 95% CI 1.24-3.16, p = 0.0042), and number of PIMs use (ꞵ = - 0.27, p < 0.0001) improved significantly in the intervention group. There was no significant difference in hypertension control rate (OR = 0.54, 95% CI 0.20-1.43, p = 0.2129), proportion of polypharmacy (OR = 1.40, 95% CI 0.75-2.60, p = 0.2863), and improvement of composite quality indicators (ꞵ = 0.03, p = 0.2094). For secondary outcomes, cognitive and motor function, quality of life, and unplanned hospitalization were not different significantly between groups. CONCLUSIONS The information technology-supported integrated health service effectively reduced PIM use and controlled diabetes among older patients in LTCH or NH without functional decline or increase of healthcare utilization. TRIAL REGISTRATION Clinical Research Information Service, KCT0004360. Registered on 21 October 2019.
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Affiliation(s)
- Jung-Yeon Choi
- Departments of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hongsoo Kim
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
- Institute of Aging, Seoul National University, Seoul, Republic of Korea
| | - Seungyeon Chun
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Young-Il Jung
- Department of Environmental Health, Korea National Open University, Seoul, Republic of Korea
| | - Sooyoung Yoo
- Healthcare ICT Research Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - In-Hwan Oh
- Department of Preventive Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Gi-Soo Kim
- Department of Industrial Engineering, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - Jin Young Ko
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Minho Lee
- Healthcare Convergence R&D Center, ezCaretech Co. Ltd, Seoul, Republic of Korea
| | - Jongseon Lee
- Healthcare Convergence R&D Center, Healthconnect Co. Ltd, Seoul, Republic of Korea
| | - Kwang-Il Kim
- Departments of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
- Departments of Internal Medicine, Seoul National University College of Medicine, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Kyeongi-do, 13620, Republic of Korea.
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Andrews MC, Woolum A, Mesmer-Magnus J, Viswesvaran C, Deshpande S. Reducing turnover intentions among first-year nurses: The importance of work centrality and coworker support. Health Serv Manage Res 2024; 37:88-98. [PMID: 36974763 DOI: 10.1177/09514848231165891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Turnover among nurses has been recognized as a frequent and enduring problem in healthcare worldwide. The widespread nursing shortage has reached the level of a healthcare crisis. The COVID-19 pandemic has illustrated the importance of understanding the contributing factors of nurse turnover, and more importantly how to mitigate the problem. Using cross-sectional survey data collected from 3370 newly licensed nurses working across 51 metropolitan areas within 35 U.S. states, we explore how role overload and work constraints can both diminish job satisfaction and increase turnover intentions of new nurses. Coworker support and work role centrality are identified as moderators of these relationships which show potential to mitigate these negative outcomes. This study highlights the importance of coworker support and work centrality in improving job satisfaction and subsequent turnover intentions among newly licensed nurses.
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Affiliation(s)
- Martha C Andrews
- University of North Carolina Wilmington Cameron School of Business, Wilmington, NC, USA
| | - Andrew Woolum
- University of North Carolina Wilmington Cameron School of Business, Wilmington, NC, USA
| | - Jessica Mesmer-Magnus
- University of North Carolina Wilmington Cameron School of Business, Wilmington, NC, USA
| | | | - Satish Deshpande
- Western Michigan University Haworth College of Business, Kalamazoo, MI, USA
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Gotanda H, Zhang JJ, Saliba D, Xu H, Tsugawa Y. Changes in Site of Death Among Older Adults Without a COVID-19 Diagnosis During the COVID-19 Pandemic. J Gen Intern Med 2024; 39:619-625. [PMID: 37946020 PMCID: PMC10973311 DOI: 10.1007/s11606-023-08482-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/12/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Understanding how the coronavirus disease 2019 (COVID-19) pandemic affected site of death-an important patient-centered outcome related to end-of-life care-would inform healthcare system resiliency in future public health emergencies. OBJECTIVE To evaluate the changes in site of death during the COVID-19 pandemic among older adults without a COVID-19 diagnosis. DESIGN Using a quasi-experimental difference-in-differences method, we estimated net changes in site of death during the pandemic period (March-December 2020) from the pre-pandemic period (January-February 2020), using data on the same months in prior years (2016-2019) as the control. PARTICIPANTS A 20% sample of Medicare Fee-for-Service beneficiaries aged 66 years and older who died in 2016-2020. We excluded beneficiaries with a hospital diagnosis of COVID-19. MAIN MEASURES We assessed each of the following sites of death separately: (1) home or community; (2) acute care hospital; and (3) nursing home. KEY RESULTS We included 1,133,273 beneficiaries without a hospital diagnosis of COVID-19. We found that the proportion of Medicare beneficiaries who died at home or in the community setting increased (difference-in-differences [DID] estimate, + 3.1 percentage points [pp]; 95% CI, + 2.6 to + 3.6 pp; P < 0.001) and the proportion of beneficiaries who died (without COVID-19 diagnosis) in an acute care hospital decreased (- 0.8 pp; 95% CI, - 1.2 to - 0.4 pp; P < 0.001) during the pandemic. We found no evidence that the proportion of deaths in nursing homes changed during the pandemic. CONCLUSIONS Using national data on older adults without a COVID-19 diagnosis, we found that site of death shifted toward home or community settings during the COVID-19 pandemic. Our findings may inform clinicians and policymakers in supporting end-of-life care during future public health emergencies.
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Affiliation(s)
- Hiroshi Gotanda
- Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Jessica J Zhang
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Debra Saliba
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Borun Center for Gerontological Research, UCLA, Los Angeles, CA, USA
- RAND Health, Santa Monica, CA, USA
| | - Haiyong Xu
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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Bowblis JR, Brunt CS, Xu H, Applebaum R, Grabowski DC. Nursing Homes Increasingly Rely On Staffing Agencies For Direct Care Nursing. Health Aff (Millwood) 2024; 43:327-335. [PMID: 38354321 PMCID: PMC10955789 DOI: 10.1377/hlthaff.2023.01101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
When nursing homes experience a shortage in directly employed nursing staff, they may rely on temporary workers from staffing agencies to fill this gap. This article examines trends in the use of staffing agencies among nursing homes during the prepandemic and COVID-19 pandemic era (2018-22). In 2018, 23 percent of nursing homes used agency nursing staff, accounting for about 3 percent of all direct care nursing hours worked. When used, agency staff were commonly present for ninety or fewer days in a year. By 2022, almost half of all nursing homes used agency staff, accounting for 11 percent of all direct care nursing staff hours. Agency staff were increasingly used to address chronic staffing shortages, with 13.8 percent of nursing homes having agency staff present every day. Agency staff were 50-60 percent more expensive per hour than directly employed nursing staff, and nursing homes that used agency staff often had lower five-star ratings. Policy makers need to consider postpandemic changes to the nursing home workforce as part of nursing home reform, as increased reliance on agency staff may reduce the financial resources available to increase nursing staff levels and improve the quality of care.
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Affiliation(s)
| | | | - Huiwen Xu
- Huiwen Xu, University of Texas Medical Branch, Galveston, Texas
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Tat DP, Zullo AR, Mor V, Hayes KN. Sliding Scale Insulin Use in Nursing Homes Before and After Onset of the COVID-19 Pandemic. J Am Med Dir Assoc 2024; 25:459-464. [PMID: 38307122 PMCID: PMC10923121 DOI: 10.1016/j.jamda.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVE To characterize sliding-scale insulin (SSI) use in US nursing homes (NHs) before and after the COVID-19 pandemic. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS A total of 129,829 US NH residents on SSI (01/2018-06/2022) across 12 NH chains with a common electronic health record system. METHODS Among all residents with at least 1 administration of SSI documented in the electronic medication administration record, we described resident demographics, frequency of SSI monotherapy vs combination therapy with another diabetes medication, number of daily capillary blood glucose readings ("fingersticks"), and hypoglycemia (capillary blood glucose <70 mg/dL) and hyperglycemia after first SSI use. We used interrupted time series analysis (ITS) with segmented linear regression models to examine whether the monthly prevalence of SSI use changed at and after the onset of the COVID-19 pandemic (March 2020). RESULTS There were 129,829 unique NH residents with SSI use [51% women, average age 71.3 (SD 11.7) years]. Of these, 36% of residents received SSI monotherapy and 64% received SSI combination therapy. Residents on SSI received an average of 3.96 (SD 1.41) fingersticks per day. Overall, 26% of SSI users experienced a hypoglycemic event within 30 days of the first SSI dose. The ITS analysis identified a step decrease in the rate of SSI use following the onset of the COVID-19 pandemic (43 fewer SSI users per 1000 insulin users) but no change in overall trend over time from before the onset of the pandemic. CONCLUSIONS AND IMPLICATIONS SSI use and fingerstick burden are high in NH residents. Hypoglycemia occurred commonly among residents on SSI. Future research should compare the safety and effectiveness of SSI monotherapy vs other diabetes medication regimens to guide person-centered prescribing decisions in NHs.
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Affiliation(s)
- Darlene P Tat
- Brown University School of Public Health, Center for Gerontology and Healthcare Research, Providence, RI, USA
| | - Andrew R Zullo
- Brown University School of Public Health, Center for Gerontology and Healthcare Research, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Vincent Mor
- Brown University School of Public Health, Center for Gerontology and Healthcare Research, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Kaleen N Hayes
- Brown University School of Public Health, Center for Gerontology and Healthcare Research, Providence, RI, USA.
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Aljadani R, Carnahan R, Culp K, Souza-Talarico JN. COVID-19 Pandemic Impact on the Trajectories of Cognitive Decline and Depression Symptoms in Long-Term Care Facility Residents. J Am Med Dir Assoc 2024; 25:328-334.e6. [PMID: 38195079 DOI: 10.1016/j.jamda.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES To compare the longitudinal rates of change in cognition and depressive symptoms between 2019 (pre-COVID-19 pandemic) and 2020 (COVID-19 pandemic) among long-term care facility (LTCF) residents in Iowa, which ranked among the top 10 US states that suffered from extreme nursing staff shortages during this crisis. DESIGN A longitudinal cohort study analyzing the Long-Term Care Minimum Data Set (MDS) version 3.0 between January 1, 2019, and December 31, 2020. SETTING AND PARTICIPANTS LTCF residents from the state of Iowa, with a first assessment before March 10 for each year (2019 and 2020), LTCF stay period >60 days, and at least 2 documented assessments with a minimum of 45 days in between. LTCF residents with a Brief Interview for Mental Status score (BIMS) <3 were excluded. METHODS We computed doubly robust estimators by combining regression and propensity score models for BIMS (cognitive decline) and Nine-item Patient Health Questionnaire (PHQ-9; depression symptoms) monthly scores for 2020 vs 2019. RESULTS A total of 24,025 residents from 436 LTCFs were included. Our research revealed a marginally accelerated monthly decline in BIMS scores during 2020 as opposed to 2019, with a rate of -0.012 per month (95% CI -0.022, -0.002; P = .016). Simultaneously, we observed a monthly increment of 0.016 in the PHQ-9 scores among LTCF residents in 2020 (95% CI 0.006, 0.028; P = .003). CONCLUSIONS AND IMPLICATIONS Our study identified a notable yet modest increase in cognitive decline and depressive symptoms among NH residents in Iowa during the COVID-19 pandemic. Although statistically significant, the changes were small and may not have clinical relevance over 1 year. Further research is needed to examine risk factors for cognitive decline during pandemic scenarios such as social isolation, loneliness, inappropriate patient-centered care, and the relationship with staff shortage and facility resources.
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Affiliation(s)
- Rawabi Aljadani
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Ryan Carnahan
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Kennith Culp
- College of Nursing, University of Iowa, Iowa City, IA, USA
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Orewa GN, Weech-Maldonado R, Lord J, Davlyatov G, Becker D, Feldman SS. COVID-19 Pandemic Impact on Nursing Homes Financial Performance. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241240698. [PMID: 38515246 PMCID: PMC10958812 DOI: 10.1177/00469580241240698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/11/2024] [Accepted: 03/01/2024] [Indexed: 03/23/2024]
Abstract
Nursing homes expressed concern about potential severe adverse financial outcomes of COVID-19, with worries extending to the possibility of some facilities facing closure. Maintaining a strong financial well-being is crucial, and there were concerns that the pandemic might have significantly impacted both expenses and income. This longitudinal study aimed to analyze the financial performance of nursing homes during COVID-19 pandemic. Specifically, we examined the impact of the pandemic on nursing home operating margins, operating revenue per resident day, and operating cost per resident day. The study utilized secondary data from various sources, including CMS Medicare cost reports, Brown University's Long Term Care Focus (LTCFocus), CMS Payroll-Based Journal, CMS Care Compare, Area Health Resource File, Provider Relief Fund distribution data, and CDC's NH COVID-19 public file. The sample consisted of 45 833 nursing home-year observations from 2018 to 2021. Fixed-effects regression analysis was employed to assess the impact of the pandemic on financial performance while controlling for various organizational and market characteristics. The study found that nursing homes' financial performance deteriorated during the COVID-19 pandemic. Operating margins decreased by approximately 4.3%, while operating costs per resident day increased by $26.51, outweighing the increase in operating revenue per resident day by about $17. Occupancy rates, payer mix, and staffing intensity were found to impact financial performance. The study highlights the significant financial impact of the COVID-19 pandemic on nursing homes. While nursing homes faced substantial financial strains, the findings offered lessons for the future, underscoring the need for nursing homes to improve the accuracy of their cost reports and enhance financial transparency and accountability.
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Affiliation(s)
| | | | - Justin Lord
- Louisiana State University in Shreveport, Shreveport, LA, USA
| | | | - David Becker
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sue S. Feldman
- University of Alabama at Birmingham, Birmingham, AL, USA
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Fung V, Levison JH, Wilson A, Cheng D, Chau C, Krane D, Trieu HD, Irwin K, Cella E, Bird B, Shellenberger K, Silverman P, Batson J, Fathi A, Gamse S, Wolfe J, Holland S, Donelan K, Samuels R, Becker JE, Freedberg KA, Reichman JL, Keller T, Tsai AC, Hsu J, Skotko BG, Bartels S. COVID-19-Related Outcomes Among Group Home Residents with Serious Mental Illness in Massachusetts in the First Year of the Pandemic. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:60-68. [PMID: 37938475 PMCID: PMC10872570 DOI: 10.1007/s10488-023-01311-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 11/09/2023]
Abstract
This study examined COVID-19 infection and hospitalizations among people with serious mental illness who resided in residential care group homes in Massachusetts during the first year of the COVID-19 pandemic. The authors analyzed data on 2261 group home residents and COVID-19 data from the Massachusetts Department of Public Health. Outcomes included positive COVID-19 tests and COVID-19 hospitalizations March 1, 2020-June 30, 2020 (wave 1) and July 1, 2020-March 31, 2021 (wave 2). Associations between hazard of outcomes and resident and group home characteristics were estimated using multi-level Cox frailty models including home- and city-level frailties. Between March 2020 and March 2021, 182 (8%) residents tested positive for COVID-19, and 51 (2%) had a COVID-19 hospitalization. Compared with the Massachusetts population, group home residents had age-adjusted rate ratios of 3.0 (4.86 vs. 1.60 per 100) for COVID infection and 13.5 (1.99 vs. 0.15 per 100) for COVID hospitalizations during wave 1; during wave 2, the rate ratios were 0.5 (4.55 vs. 8.48 per 100) and 1.7 (0.69 vs. 0.40 per 100). In Cox models, residents in homes with more beds, higher staff-to-resident ratios, recent infections among staff and other residents, and in cities with high community transmission risk had greater hazard of COVID-19 infection. Policies and interventions that target group home-specific risks are needed to mitigate adverse communicable disease outcomes in this population.Clinical Trial Registration Number This study provides baseline (i.e., pre-randomization) data from a clinical trial study NCT04726371.
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Affiliation(s)
- Vicki Fung
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA.
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Julie H Levison
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Anna Wilson
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
| | - David Cheng
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Cindy Chau
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
| | - David Krane
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
| | - Hao D Trieu
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
| | - Kelly Irwin
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | | | | | | | | | | | | | - Karen Donelan
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ronita Samuels
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
| | - Jessica E Becker
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Kenneth A Freedberg
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Alexander C Tsai
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - John Hsu
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Brian G Skotko
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Stephen Bartels
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Brunt CS, Bowblis JR. Beyond Nursing Staff Levels: The Association of Nursing Home Quality and the Five-Star Quality Rating System's New Staffing Measures. Med Care Res Rev 2023; 80:631-640. [PMID: 37461396 DOI: 10.1177/10775587231187782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Recently, the Centers for Medicare & Medicaid Services (CMS) introduced staffing measures related to staffing variability and turnover in the Nursing Home (NH) Care Compare Five-Star Quality Rating System. While the consensus within the literature is that reduced variability and turnover are associated with higher NH quality of care and life, no existing studies have evaluated the relationship between CMS's newly introduced staffing measures and quality. This study uses regression analysis to estimate the relationship between 13 quality measures (used in Care Compare) and CMS's new staffing measures (i.e., weekend nursing staff levels, total nursing and registered nurse staff turnover, and administrator turnover) as well as a measure of daily staffing variation recently introduced in the literature called the coefficient of variation. Regressions analysis finds strong evidence of an association between quality and these staffing measures, though some measures (e.g., nursing staff turnover) are highly correlated and may be duplicative.
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Sohn J, Polizzi M, McDonagh PR, Guy C, Datsang R, Weiss E, Kim S. Shallow kinetics induced by a metronome (SKIM): A novel contactless respiratory motion management. J Appl Clin Med Phys 2023; 24:e14147. [PMID: 37672210 PMCID: PMC10691643 DOI: 10.1002/acm2.14147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/26/2023] [Accepted: 08/03/2023] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVES As an alternative to conventional compression amidst the COVID-19 pandemic, we developed a contactless motion management strategy. By increasing the patient's breathing rate to induce shallow breathing with the aid of a metronome, our hypothesis is that the motion magnitude of the target may be minimized without physical contact or compression. METHODS Fourteen lung stereotactic body radiation therapy (SBRT) patients treated under fast shallow-breathing (FSB) were selected for inclusion in this retrospective study. Our proposed method is called shallow kinetics induced by a metronome (SKIM). We induce FSB by setting the beats-per-minute (BPM) high (typically in the range of 50-60). This corresponded to a patient breathing rate of 25-30 (breathing) cycles per minute. The magnitude of target motion in 3D under SKIM was evaluated using 4DCT datasets. Comparison with free breathing (FB) 4DCT was also made for a subset for which FB data available. RESULTS The overall effectiveness of SKIM was evaluated with 18 targets (14 patients). Direct comparison with FB was performed with 12 targets (10 patients). The vector norm mean ± SD value of motion magnitude under SKIM for 18 targets was 8.2 ± 4.1 mm. The mean ± SD metronome BPM was 54.9 ± 4.0 in this group. The vector norm means ± SD values of target motion for FB and SKIM in the 12 target sub-group were 14.6 ± 8.5 mm and 9.3 ± 3.7 mm, respectively. The mean ± SD metronome BPM for this sub-group was 56.3 ± 2.5. CONCLUSION Compared with FB, SKIM can significantly reduce respiratory motion magnitude of thoracic targets. The difference in maximum motion reduction in the overall vector norm, S-I, and A-P directions was significant (p = 0.033, 0.042, 0.011). Our proposed method can be an excellent practical alternative to conventional compression due to its flexibility and ease of implementation.
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Affiliation(s)
- James Sohn
- Department of Radiation OncologyNorthwestern Memorial HospitalNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Mitchell Polizzi
- Department of Radiation OncologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Philip Reed McDonagh
- Department of Radiation OncologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Christopher Guy
- Department of Radiation OncologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Rabten Datsang
- Department of Radiation OncologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Elisabeth Weiss
- Department of Radiation OncologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Siyong Kim
- Department of Radiation OncologyVirginia Commonwealth UniversityRichmondVirginiaUSA
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Reses HE, Soe M, Dubendris H, Segovia G, Wong E, Shafi S, Kalayil EJ, Lu M, Bagchi S, Edwards JR, Benin AL, Bell JM. Coronavirus disease 2019 (COVID-19) vaccination rates and staffing shortages among healthcare personnel in nursing homes before, during, and after implementation of mandates for COVID-19 vaccination among 15 US jurisdictions, National Healthcare Safety Network, June 2021-January 2022. Infect Control Hosp Epidemiol 2023; 44:1840-1849. [PMID: 37144294 PMCID: PMC10665878 DOI: 10.1017/ice.2023.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/31/2023] [Accepted: 04/08/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To examine temporal changes in coverage with a complete primary series of coronavirus disease 2019 (COVID-19) vaccination and staffing shortages among healthcare personnel (HCP) working in nursing homes in the United States before, during, and after the implementation of jurisdiction-based COVID-19 vaccination mandates for HCP. SAMPLE AND SETTING HCP in nursing homes from 15 US jurisdictions. DESIGN We analyzed weekly COVID-19 vaccination data reported to the Centers for Disease Control and Prevention's National Healthcare Safety Network from June 7, 2021, through January 2, 2022. We assessed 3 periods (preintervention, intervention, and postintervention) based on the announcement of vaccination mandates for HCP in 15 jurisdictions. We used interrupted time-series models to estimate the weekly percentage change in vaccination with complete primary series and the odds of reporting a staffing shortage for each period. RESULTS Complete primary series vaccination among HCP increased from 66.7% at baseline to 94.3% at the end of the study period and increased at the fastest rate during the intervention period for 12 of 15 jurisdictions. The odds of reporting a staffing shortage were lowest after the intervention. CONCLUSIONS These findings demonstrate that COVID-19 vaccination mandates may be an effective strategy for improving HCP vaccination coverage in nursing homes without exacerbating staffing shortages. These data suggest that mandates can be considered to improve COVID-19 coverage among HCP in nursing homes to protect both HCP and vulnerable nursing home residents.
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Affiliation(s)
- Hannah E. Reses
- Surveillance Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Minn Soe
- Surveillance Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Heather Dubendris
- Surveillance Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Lantana Consulting Group, East Thetford, Vermont
| | - George Segovia
- Surveillance Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily Wong
- Surveillance Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shanjeeda Shafi
- Surveillance Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Goldbelt C6, Chesapeake, Virginia
| | - Elizabeth J. Kalayil
- Surveillance Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Lantana Consulting Group, East Thetford, Vermont
| | - Meng Lu
- Surveillance Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Suparna Bagchi
- Surveillance Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jonathan R. Edwards
- Surveillance Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea L. Benin
- Surveillance Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeneita M. Bell
- Surveillance Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Chen M, Goodwin JS, Bailey JE, Bowblis JR, Li S, Xu H. Longitudinal Associations of Staff Shortages and Staff Levels with Health Outcomes in Nursing Homes. J Am Med Dir Assoc 2023; 24:1755-1760.e7. [PMID: 37263319 PMCID: PMC10826288 DOI: 10.1016/j.jamda.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To examine whether facility-reported staff shortages and total staff levels were independently associated with changes in nursing home (NH) outcomes in 2020. DESIGN Longitudinal cohort study. SETTING AND PARTICIPANTS A total of 8466 NHs with staffing and outcome data. METHODS This study used NH COVID-19 Public File (2020), Nursing Home Compare (2019-2020), and Payroll-Based Journal data (2019-2020). Outcome measures included the percentage of long-stay residents in a facility with declines in activities in daily living (ADLs), decreases in mobility, weight loss, and pressure ulcers in 2020 Q2, 2020 Q3, and 2020 Q4. Independent variables were whether NHs reported any shortage of aides or licensed nurses and total staff hours per resident day (HPRD). Separate 2-level (NH, state) Hierarchical Generalized Linear Mixed models examined the association of facility-reported shortages and staff hours with key NH resident outcomes, controlling for NH characteristics and COVID-19 infections. RESULTS The weekly percentage of NHs reporting any staff shortage averaged 20%. Total staff HPRD increased slightly from 3.7 in 2019 to 3.8 in 2020. Health outcomes were stable during 2019 and 2020 Q1 but worsened substantially starting in 2020 Q2. For example, the percentage of residents with mobility loss increased from 16.2% in 2020 Q1 to 27.9% in 2020 Q4. Facility-reported staff shortages were associated with an increase in the proportion of residents with an ADL decline (0.54 percentage points), mobility loss (0.80 percentage points), weight loss (0.22 percentage points), and pressure ulcers (0.22 percentage points) (all P < .01). Total staff HPRD was not associated with changes in any outcomes (all P > .05). CONCLUSIONS AND IMPLICATIONS NHs reported worsened health outcomes among long-stay residents in 2020, with worse outcomes found among facilities that reported staff shortages but not among those with lower total staff levels. Facility-reported shortages provide important quality information during the COVID-19 pandemic.
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Affiliation(s)
- Ming Chen
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, USA; Institute of Health Outcomes and Policy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - James S Goodwin
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA; Department of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - James E Bailey
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, USA; Institute of Health Outcomes and Policy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - John R Bowblis
- Department of Economics, Farmer School of Business, Miami University, Oxford, OH, USA; Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Shuang Li
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
| | - Huiwen Xu
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA; School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA.
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Lane SJ, Liu D, Rados R. Post-Acute and Long-Term Care Leaders' Perspectives on Leading During COVID-19. J Appl Gerontol 2023; 42:2179-2188. [PMID: 37409575 PMCID: PMC10331110 DOI: 10.1177/07334648231188282] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
Post-acute and long-term care (PALTC) delivery is complex, and the COVID-19 pandemic created additional complexities. This qualitative study investigates how PALTC administrators responded to the pandemic, factors that impacted their leadership role and decision-making. Participants from North Carolina (N = 15) and Pennsylvania (N = 6) were interviewed using an interview guide containing open-ended questions. The results revealed three themes: (1) critical knowledge and competencies; (2) resources, supports and essential actions taken; and (3) psychosocial impact. The findings suggest communication and relationship building were the most useful competencies. Lack of staff was a primary stress point during and after the pandemic.
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Affiliation(s)
- Sandi J. Lane
- Department of Health Care Management, Appalachian State University, Boone, NC, USA
| | - Darren Liu
- Department of Health Policy, Management, and Leadership, West Virginia University, Morgantown, WV, USA
| | - Robert Rados
- Department of Health Care Management, Southern Illinois University, Carbondale, IL, USA
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Leland NE, Rouch SA, Prusynski RA, Shore AD, Kaufman H, Hoover LP, Mroz TM, Freburger JK, Saliba D. Implementation of US Post-Acute Care Payment Reform and COVID-19 Policies: Examining Experiences of Health System Leaders, Staff, Patients, and Family Caregivers-A Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6959. [PMID: 37887697 PMCID: PMC10606322 DOI: 10.3390/ijerph20206959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
In fiscal year 2020, new national Medicare payment models were implemented in the two most common post-acute care settings (i.e., skilled nursing facilities (SNFs) and home health agencies (HHAs)), which were followed by the emergence of COVID-19. Given concerns about the unintended consequence of these events, this study protocol will examine how organizations responded to these policies and whether there were changes in SNF and HHA access, care delivery, and outcomes from the perspectives of leadership, staff, patients, and families. We will conduct a two-phase multiple case study guided by the Institute of Medicine's Model of Healthcare Systems. Phase I will include three cases for each setting and a maximum of fifty administrators per case. Phase II will include a subset of Phase I organizations, which are grouped into three setting-specific cases. Each Phase II case will include a maximum of four organizations. Semi-structured interviews will explore the perspectives of frontline staff, patients, and family caregivers (Phase II). Thematic analysis will be used to examine the impact of payment policy and COVID-19 on organizational operations, care delivery, and patient outcomes. The results of this study intend to develop evidence addressing concerns about the unintended consequences of the PAC payment policy during the COVID-19 pandemic.
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Affiliation(s)
- Natalie E. Leland
- Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA; (S.A.R.); (A.D.S.)
| | - Stephanie A. Rouch
- Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA; (S.A.R.); (A.D.S.)
- The Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Rachel A. Prusynski
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA; (R.A.P.); (H.K.); (T.M.M.)
| | - Amanda D. Shore
- Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA; (S.A.R.); (A.D.S.)
| | - Hannah Kaufman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA; (R.A.P.); (H.K.); (T.M.M.)
| | - Lorelei P. Hoover
- Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA; (S.A.R.); (A.D.S.)
| | - Tracy M. Mroz
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA; (R.A.P.); (H.K.); (T.M.M.)
| | - Janet K. Freburger
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA;
| | - Debra Saliba
- Veterans Affairs (VA) Greater Los Angeles Geriatrics Research Education and Clinical Center (GRECC), Los Angeles, CA 90095, USA;
- Borun Center, University of California, Los Angeles, CA 90095, USA
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Cavalcante de Oliveira AP, Galante ML, Maia LS, Craveiro I, da Silva AP, Fronteira I, Chança R, Cometto G, Ferrinho P, Dal Poz M. Implementation of policy and management interventions to improve health and care workforce capacity to address the COVID-19 pandemic response: a systematic review. HUMAN RESOURCES FOR HEALTH 2023; 21:80. [PMID: 37817165 PMCID: PMC10563305 DOI: 10.1186/s12960-023-00856-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/14/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND The COVID-19 pandemic highlighted pre-existing weaknesses in health and care systems and services and shortages of health and care workers (HCWs). As a result, policymakers needed to adopt measures to improve the health and care workforce (HCWF) capacity. This review aims to identify countries' range of policies and management interventions implemented to improve HCWs' capacity to address the COVID-19 pandemic response, synthesize their evidence on effectiveness, and identify gaps in the evidence. METHODS The literature was searched in PubMed, Embase, Scopus, LILACS-BVS, WHO's COVID-19 Research Database and the ILO, OECD and HSRM websites for literature and documents published between January 2020 and March 2022. Eligibility criteria were HCWs as participants and policy and management interventions aiming to improve HCWF capacity to address the COVID-19 pandemic response. Risk of bias was assessed with Joanna Briggs Institute (JBI) Critical Appraisal Tools (CAT) and certainty of the evidence in presented outcomes with GRADE. RESULTS The searches retrieved 3378 documents. A total of 69 were included, but only 8 presented outcomes of interventions implemented. Most of the selected documents described at least one intervention implemented by countries at the organizational environment level to increase the flexibility and capacity of the HCWF to respond to the pandemic, followed by interventions to attract and retain HCWs in safe and decent working environments. There was a lack of studies addressing social protection, human resources for health information systems, and regarding the role of community health workers and other community-based providers. Regarding the risk of bias, most of documents were rated as medium or high quality (JBI's CAT), while the evidence presented for the outcomes of interventions was classified as mostly low-certainty evidence (GRADE). CONCLUSIONS Countries have implemented various interventions, some innovative, in response to the pandemic, and others had their processes started earlier and accelerated by the pandemic. The evidence regarding the impact and efficacy of the strategies used by countries during the pandemic still requires further research.
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Affiliation(s)
- Ana Paula Cavalcante de Oliveira
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier 524-7º andar, Blocos D e E-Maracanã, Rio de Janeiro, RJ, 20550-013, Brazil.
| | - Mariana Lopes Galante
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier 524-7º andar, Blocos D e E-Maracanã, Rio de Janeiro, RJ, 20550-013, Brazil
| | - Leila Senna Maia
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier 524-7º andar, Blocos D e E-Maracanã, Rio de Janeiro, RJ, 20550-013, Brazil
| | - Isabel Craveiro
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, NOVA University of Lisbon, Rua da Junqueira, 100, 1349-008, Lisbon, Portugal
| | - Alessandra Pereira da Silva
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier 524-7º andar, Blocos D e E-Maracanã, Rio de Janeiro, RJ, 20550-013, Brazil
| | - Ines Fronteira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, NOVA University of Lisbon, Rua da Junqueira, 100, 1349-008, Lisbon, Portugal
- National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, NOVA University of Lisbon, Avenida Padre Cruz, 1600-560, Lisbon, Portugal
| | - Raphael Chança
- Instituto Nacional de Cancer, Ministério da Saúde, Rua Marquês de Pombal, 125, Centro, Rio de Janeiro, RJ, 20230240, Brazil
| | - Giorgio Cometto
- Health Workforce Department, World Health Organization, Av. Appia 20, 1202, Geneva, Switzerland
| | - Paulo Ferrinho
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, NOVA University of Lisbon, Rua da Junqueira, 100, 1349-008, Lisbon, Portugal
| | - Mario Dal Poz
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier 524-7º andar, Blocos D e E-Maracanã, Rio de Janeiro, RJ, 20550-013, Brazil
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Bakare RA, Mulcahy JF, Pullen MF, Demmer RT, Cox SL, Thurn JA, Galdys AL. Patient-facing job role is associated with SARS-CoV-2 positivity among healthcare workers in long term care facilities in Minnesota, August-December, 2020. Infect Control Hosp Epidemiol 2023; 44:1467-1471. [PMID: 36912330 PMCID: PMC10507513 DOI: 10.1017/ice.2022.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 03/14/2023]
Abstract
OBJECTIVE Healthcare workers (HCWs) in long-term care facilities (LTCFs) are disproportionately affected by severe acute respiratory coronavirus virus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19). To characterize factors associated with SARS-CoV-2 positivity among LTCF HCWs, we performed a retrospective cohort study among HCWs in 32 LTCFs in the Minneapolis-St Paul region. METHODS We analyzed the outcome of SARS-CoV-2 polymerase chain reaction (PCR) positivity among LTCF HCWs during weeks 34-52 of 2020. LTCF and HCW-level characteristics, including facility size, facility risk score for resident-HCW contact, and resident-facing job role, were modeled in univariable and multivariable generalized linear regressions to determine their association with SARS-CoV-2 positivity. RESULTS Between weeks 34 and 52, 440 (20.7%) of 2,130 unique HCWs tested positive for SARS-CoV-2 at least once. In the univariable model, non-resident-facing HCWs had lower odds of infection (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.36-0.70). In the multivariable model, the odds remained lower for non-resident-facing HCW (OR, 0.50; 95% CI, 0.36-0.71), and those in medium- versus low-risk facilities experienced higher odds of testing positive for SARS-CoV-2 (OR, 1.47; 95% CI, 1.08-2.02). CONCLUSIONS Our findings suggest that COVID-19 cases are related to contact between HCW and residents in LTCFs. This association should be considered when formulating infection prevention and control policies to mitigate the spread of SARS-CoV-2 in LTCFs.
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Affiliation(s)
| | - John F. Mulcahy
- University of Minnesota School of Public Health, Minneapolis, Minnesota
| | | | - Ryan T. Demmer
- University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Sara L. Cox
- M Health Fairview Health System, Minneapolis, Minnesota
| | | | - Alison L. Galdys
- University of Minnesota School of Medicine, Minneapolis, Minnesota
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Dean A, McCallum J, Venkataramani AS, Michaels D. The Effect Of Labor Unions On Nursing Home Compliance With OSHA's Workplace Injury And Illness Reporting Requirement. Health Aff (Millwood) 2023; 42:1260-1265. [PMID: 37669485 DOI: 10.1377/hlthaff.2023.00255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
All US nursing homes are required to report workplace injury and illness data to the Occupational Safety And Health Administration (OSHA). Nevertheless, the compliance rate for US nursing homes during the period 2016-21 was only 40 percent. We examined whether unionization increases the probability that nursing homes will comply with that requirement. Using a difference-in-differences design and proprietary data on union status from the Service Employees International Union for all forty-eight continental US states from the period 2016-21, we found that two years after unionization, nursing homes were 31.1 percentage points more likely than nonunion nursing homes to report workplace injury and illness data to OSHA. Data on injuries occurring in specific workplaces play a central role in injury prevention. Further unionization could help improve workplace safety in nursing homes, a sector with one of the highest occupational injury and illness rates in the US.
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Affiliation(s)
- Adam Dean
- Adam Dean , George Washington University, Washington, D.C
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23
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Nguemeni Tiako MJ, Browne A. How race, sex and age interact in association with COVID-19 outcomes over time: An analysis of Michigan data. PLoS One 2023; 18:e0288383. [PMID: 37651422 PMCID: PMC10470902 DOI: 10.1371/journal.pone.0288383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 06/26/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND COVID-19 has had a disproportionate impact on racial and ethnic minorities compared to White people. Studies have not sufficiently examined how sex and age interact with race/ethnicity, and potentially shape COVID-19 outcomes. We sought to examine disparities in COVID-19 outcomes by race, sex and age over time, leveraging data from Michigan, the only state whose Department of Health and Human Services (DHSS) publishes cross-sectional race, sex and age data on COVID-19. METHODS This is an observational study using publicly available COVID-19 data (weekly cases, deaths, and vaccinations) from August 31 2020 to June 9 2021. Outcomes for descriptive analysis were age-standardized COVID-19 incidence and mortality rates, case-fatality rates by race, sex, and age, and within-gender and within-race incidence rate ratios and mortality rate ratios. We used descriptive statistics and linear regressions with age, race, and sex as independent variables. RESULTS The within-sex Black-White racial gap in COVID-19 incidence and mortality decreased at a similar rate among men and women but the remained wider among men. As of June 2021, compared to White people, incidence was lower among Asian American and Pacific Islander people by 2644 cases per 100,000 people and higher among Black people by 1464 cases per 100,000 people. Mortality was higher among those aged 60 or greater by 743.6 deaths per 100,000 people vs those 0-39. The interaction between race and age was significant between Black race and age 60 or greater, with an additional 708.5 deaths per 100,000 people vs White people aged 60 or greater. Black people had a higher case fatality rate than White people. CONCLUSION COVID-19 incidence, mortality and vaccination patterns varied over time by race, age and sex. Black-White disparities decreased over time, with a larger effect on Black men, and Older Black people were particularly more vulnerable to COVID-19 in terms of mortality. Considering different individual characteristics such as age may further help elucidate the mechanisms behind racial and gender health disparities.
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Affiliation(s)
- Max Jordan Nguemeni Tiako
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Alyssa Browne
- Department of Sociology, UNC Chapel Hill, Chapel Hill, NC, United States of America
- Carolina Population Center, UNC Chapel Hill, Chapel Hill, NC, United States of America
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Festa N, Katz-Christy N, Weiss M, Lisk R, Normand SL, Grabowski DC, Newhouse JP, Hsu J. Nursing home infection control strategies during the COVID-19 pandemic. J Am Geriatr Soc 2023; 71:2593-2600. [PMID: 37218116 PMCID: PMC10702332 DOI: 10.1111/jgs.18402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/24/2023] [Accepted: 04/20/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND The American Rescue Plan Act of 2021 awarded $500 million toward scaling "strike teams" to mitigate the impact of Coronavirus Disease 2019 (COVID-19) within nursing homes. The Massachusetts Nursing Facility Accountability and Support Package (NFASP) piloted one such model during the first weeks of the pandemic, providing nursing homes financial, administrative, and educational support. For a subset of nursing homes deemed high-risk, the state offered supplemental, in-person technical infection control support. METHODS Using state death certificate data and federal nursing home occupancy data, we examined longitudinal all-cause mortality per 100,000 residents and changes in occupancy across NFASP participants and subgroups that varied in their receipt of the supplemental intervention. RESULTS Nursing home mortality peaked in the weeks preceding the NFASP, with a steeper increase among those receiving the supplemental intervention. There were contemporaneous declines in weekly occupancy. The potential for temporal confounding and differential selection across NFASP subgroups precluded estimation of causal effects of the intervention on mortality. CONCLUSIONS We offer policy and design suggestions for future strike team iterations that could inform the allocation of state and federal funding. We recommend expanded data collection infrastructure and, ideally, randomized assignment to intervention subgroups to support causal inference as strike team models are scaled under the direction of state and federal agencies.
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Affiliation(s)
- Natalia Festa
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- National Clinician Scholars Program at Yale University, New Haven, Connecticut
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nina Katz-Christy
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Max Weiss
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rebecca Lisk
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sharon-Lise Normand
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - David C. Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Joseph P. Newhouse
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Harvard Kennedy School, Cambridge, Massachusetts
- National Bureau of Economic Research, Cambridge, Massachusetts
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - John Hsu
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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25
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Mbalayen F, Mir S, de l'Estoile V, Letty A, Le Bruchec S, Pondjikli M, Seringe E, Berrut G, Kabirian F, Fourrier MA, Armaingaud D, Josseran L, Delarocque-Astagneau E, Gautier S. Impact of the first COVID-19 epidemic wave in a large French network of nursing homes: a cross-sectional study. BMC Geriatr 2023; 23:406. [PMID: 37400803 DOI: 10.1186/s12877-023-04078-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 05/30/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Nursing homes (NHs) have been particularly affected by COVID-19. The aim of this study is to estimate the burden of COVID-19 and to investigate factors associated with mortality during the first epidemic wave in a large French NHs network. METHODS An observational cross-sectional study was conducted in September-October 2020. 290 NHs were asked to complete an online questionnaire covering the first epidemic wave on facilities and resident characteristics, number of suspected/confirmed COVID-19 deaths, and preventive/control measures taken at the facility level. Data were crosschecked using routinely collected administrative data on the facilities. The statistical unit of the study was the NH. Overall COVID-19 mortality rate was estimated. Factors associated with COVID-19 mortality were investigated using a multivariable multinomial logistic regression. The outcome was classified in 3 categories: "no COVID-19 death in a given NH", occurrence of an "episode of concern" (at least 10% of the residents died from COVID-19), occurrence of a "moderate episode" (deaths of COVID-19, less than 10% of the residents). RESULTS Of the 192 (66%) participating NHs, 28 (15%) were classified as having an "episode of concern". In the multinomial logistic regression, moderate epidemic magnitude in the NHs county (adjusted OR = 9.3; 95%CI=[2.6-33.3]), high number of healthcare and housekeeping staff (aOR = 3.7 [1.2-11.4]) and presence of an Alzheimer's unit (aOR = 0.2 [0.07-0.7]) were significantly associated with an "episode of concern". CONCLUSIONS We found a significant association between the occurrence of an "episode of concern" in a NH and some of its organizational characteristics and the epidemic magnitude in the area. These results can be used to improve the epidemic preparedness of NHs, particularly regarding the organization of NHs in small units with dedicated staff. Factors associated with COVID-19 mortality and preventive measures taken in nursing homes in France during the first epidemic wave.
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Affiliation(s)
- Fabrice Mbalayen
- University Department Public Health, Prevention, Observation, Territories - UFR Simone Veil - Santé, Université Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France.
| | - Sarah Mir
- Département hospitalier d'épidémiologie et de santé publique, hôpital Raymond-Poincaré, Groupe hospitalier universitaire Université Paris-Saclay, Assistance publique- Hôpitaux de Paris, Garches, France
| | | | - Aude Letty
- Korian Foundation for the Ageing Well, Korian, Paris, SA, France
| | - Solenn Le Bruchec
- Gérontopôle Autonomie Longévité Pays de la Loire, Nantes, 44200, France
| | - Manon Pondjikli
- Gérontopôle Autonomie Longévité Pays de la Loire, Nantes, 44200, France
| | - Elise Seringe
- Centre d'appui pour la prévention des infections associées aux soins - CPias Île-de-France, Paris, France
| | - Gilles Berrut
- Gérontopôle Autonomie Longévité Pays de la Loire, Nantes, 44200, France
- Centre Hospitalier Universitaire de Nantes, Pôle Hospitalo-Universitaire de Gérontologie Clinique, Nantes, France
| | - Fariba Kabirian
- Korian SA, Medical, Ethics and Quality Department, Paris, France
| | | | - Didier Armaingaud
- Korian Foundation for the Ageing Well, Korian, Paris, SA, France
- Korian SA, Medical, Ethics and Quality Department, Paris, France
| | - Loïc Josseran
- University Department Public Health, Prevention, Observation, Territories - UFR Simone Veil - Santé, Université Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
- Département hospitalier d'épidémiologie et de santé publique, hôpital Raymond-Poincaré, Groupe hospitalier universitaire Université Paris-Saclay, Assistance publique- Hôpitaux de Paris, Garches, France
- Centre de recherche en épidémiologie et santé des populations, UMR 1018, Université de Versailles-Saint-Quentin-en-Yvelines, Université Paris-Saclay, Montigny-Le-Bretonneux, France
| | - Elisabeth Delarocque-Astagneau
- University Department Public Health, Prevention, Observation, Territories - UFR Simone Veil - Santé, Université Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
- Département hospitalier d'épidémiologie et de santé publique, hôpital Raymond-Poincaré, Groupe hospitalier universitaire Université Paris-Saclay, Assistance publique- Hôpitaux de Paris, Garches, France
- Centre de recherche en épidémiologie et santé des populations, UMR 1018, Université de Versailles-Saint-Quentin-en-Yvelines, Université Paris-Saclay, Montigny-Le-Bretonneux, France
| | - Sylvain Gautier
- University Department Public Health, Prevention, Observation, Territories - UFR Simone Veil - Santé, Université Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
- Département hospitalier d'épidémiologie et de santé publique, hôpital Raymond-Poincaré, Groupe hospitalier universitaire Université Paris-Saclay, Assistance publique- Hôpitaux de Paris, Garches, France
- Centre de recherche en épidémiologie et santé des populations, UMR 1018, Université de Versailles-Saint-Quentin-en-Yvelines, Université Paris-Saclay, Montigny-Le-Bretonneux, France
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Travers JL, McGarry BE, Friedman S, Holaday LW, Ross JS, Lopez L, Chen K. Association of Receipt of Paycheck Protection Program Loans With Staffing Patterns Among US Nursing Homes. JAMA Netw Open 2023; 6:e2326122. [PMID: 37498597 PMCID: PMC10375300 DOI: 10.1001/jamanetworkopen.2023.26122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 05/30/2023] [Indexed: 07/28/2023] Open
Abstract
Importance Staffing shortages in nursing homes (NHs) threaten the quality of resident care, and the COVID-19 pandemic magnified critical staffing shortages within NHs. During the pandemic, the US Congress enacted the Paycheck Protection Program (PPP), a forgivable loan program that required eligible recipients to appropriate 60% to 75% of the loan toward staffing to qualify for loan forgiveness. Objective To evaluate characteristics of PPP loan recipient NHs vs nonloan recipient NHs and whether there were changes in staffing hours at NHs that received a loan compared with those that did not. Design, Setting, and Participants This economic evaluation used national data on US nursing homes that were aggregated from the Small Business Administration, Nursing Home Compare, LTCFocus, the Centers for Medicare & Medicaid Services Payroll Based Journal, the Minimum Data Set, the Area Deprivation Index, the Healthcare Cost Report Information System, and the US Department of Agriculture Rural-Urban Continuum Codes from January 1 to December 23, 2020. Exposure Paycheck Protection Program loan receipt status. Main Outcome and Measures Staffing variables included registered nurse, licensed practical nurse (LPN), and certified nursing assistant (CNA) total hours per week. Staffing hours were examined on a weekly basis before and after loan receipt during the study period. An event-study approach was used to estimate the staffing total weekly hours at NHs that received PPP loans compared with NHs that did not receive a PPP loan. Results Among 6008 US NHs, 1807 (30.1%) received a PPP loan and 4201 (69.9%) did not. The median loan amount was $664 349 (IQR, $407 000-$1 058 300). Loan recipients were less likely to be part of a chain (733 [40.6%] vs 2592 [61.7%]) and more likely to be for profit (1342 [74.3%] vs 2877 [68.5%]), be located in nonurban settings (159 [8.8%] vs 183 [4.4%]), have a greater proportion of Medicaid-funded residents (mean [SD], 60.92% [21.58%] vs 56.78% [25.57%]), and have lower staffing quality ratings (mean [SD], 2.88 [1.20] vs 3.03 [1.22]) and overall quality star ratings (mean [SD], 3.08 [1.44] vs 3.22 [1.44]) (P < .001 for all). Twelve weeks after PPP loan receipt, NHs that received a PPP loan experienced a mean difference of 26.19 more CNA hours per week (95% CI, 14.50-37.87 hours per week) and a mean difference of 6.67 more LPN hours per week (95% CI, 1.21-12.12 hours per week) compared with nursing homes that did not receive a PPP loan. No associations were found between PPP loan receipt and weekly RN staffing hours (12 weeks: mean difference, 1.99 hours per week; 95% CI, -2.38 to 6.36 hours per week). Conclusions and Relevance In this economic evaluation, a forgivable loan program that required funding to be appropriated toward staffing was associated with a significant increase in CNA and LPN staffing hours among NH PPP loan recipients. Because the PPP loans are temporary, federal and state entities may need to institute sufficient and sustainable support to mitigate NH staffing shortages.
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Affiliation(s)
- Jasmine L. Travers
- Rory Meyers College of Nursing, New York University Grossman School of Medicine, New York
| | - Brian E. McGarry
- Division of Geriatrics and Aging, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Steven Friedman
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Louisa W. Holaday
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joseph S. Ross
- Section of General Medicine and the National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut
| | - Leo Lopez
- Institute for Public Health, University Health, University Medicine Associates, San Antonio, Texas
| | - Kevin Chen
- Office of Ambulatory Care and Population Health, New York City Health + Hospitals, New York
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University Grossman School of Medicine, New York
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Ulyte A, Waken RJ, Epstein AM, Orav EJ, Barnett ML, Joynt Maddox KE, Grabowski DC. Medicare Skilled Nursing Facility Use and Spending Before and After Introduction of the Public Health Emergency Waiver During the COVID-19 Pandemic. JAMA Intern Med 2023; 183:637-645. [PMID: 37093607 PMCID: PMC10126940 DOI: 10.1001/jamainternmed.2023.0770] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/16/2023] [Indexed: 04/25/2023]
Abstract
Importance In response to the COVID-19 pandemic, Medicare introduced a public health emergency (PHE) waiver in March 2020, removing a 3-day hospitalization requirement before fee-for-service beneficiaries could receive skilled nursing facility (SNF) care benefits. Objective To assess whether there were changes in SNF episode volume and Medicare spending on SNF care before and during the PHE among long-term care (LTC) residents and other Medicare beneficiaries. Design, Setting, and Participants This retrospective cohort study used Medicare fee-for-service claims and the Minimum Data Set for Medicare beneficiaries who were reimbursed for SNF care episodes from January 2018 to September 2021 in US SNFs. Exposures The prepandemic period (January 2018-February 2020) vs the PHE period (March 2020-September 2021). Main Outcomes and Measures The main outcomes were SNF episode volume, characteristics, and costs. Episodes were defined as standard (with a preceding 3-day hospitalization) or waiver (with other or no acute care use). Results Skilled nursing facility care was provided to 4 299 863 Medicare fee-for-service beneficiaries. Medicare beneficiaries had on average 130 400 monthly SNF episodes in the prepandemic period (mean [SD] age of beneficiaries, 78.9 [11.0] years; 59% female) and 108 575 monthly episodes in the PHE period (mean [SD] age of beneficiaries, 79.0 [11.1] years; 59% female). All waiver episodes increased from 6% to 32%, and waiver episodes without preceding acute care increased from 3% to 18% (from 4% to 49% among LTC residents). Skilled nursing facility episodes provided for LTC residents increased by 77% (from 15 538 to 27 537 monthly episodes), primarily due to waiver episodes provided for residents with COVID-19 in 2020 and early 2021 (62% of waiver episodes without preceding acute care). Skilled nursing facilities in the top quartile of waiver episodes were more often for-profit (80% vs 68%) and had lower quality ratings (mean [SD] overall star rating, 2.7 [1.4] vs 3.2 [1.4]; mean [SD] staffing star rating, 2.5 [1.1] vs 3.0 [1.2]) compared with SNFs in the other quartiles. Monthly Medicare spending on SNF care was $2.1 billion before the pandemic and $2.0 billion during the PHE. For LTC residents, monthly SNF spending increased from $301 million to $585 million while spending on hospitalizations remained relatively stable. Conclusions and Relevance This cohort study found that the PHE waiver for SNF care was associated with a marked increase in the prevalence of SNF episodes without a preceding hospitalization, especially in the first year of the COVID-19 pandemic. The waiver was used primarily among certain types of facilities and for LTC residents with COVID-19. Although the effect of the waiver cannot be differentiated from that of the pandemic, overall SNF care costs did not increase substantially; for LTC residents, the waiver was applied primarily for COVID-19 care, suggesting the waiver's successful implementation.
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Affiliation(s)
- Agne Ulyte
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - R. J. Waken
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Arnold M. Epstein
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - E. John Orav
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Michael L. Barnett
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Karen E. Joynt Maddox
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
- Center for Health Economics & Policy, Institute for Public Health, Washington University in St. Louis, St. Louis, Missouri
| | - David C. Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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28
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Zarei HR, Ghanbarpour Mamaghani M, Ergun O, Yu P, Winchester L, Chen E. Matching medical staff to long term care facilities to respond to COVID-19 outbreak. BMC Health Serv Res 2023; 23:583. [PMID: 37287022 DOI: 10.1186/s12913-023-09594-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 05/23/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Staff shortage is a long-standing issue in long term care facilities (LTCFs) that worsened with the COVID-19 outbreak. Different states in the US have employed various tools to alleviate this issue in LTCFs. We describe the actions taken by the Commonwealth of Massachusetts to assist LTCFs in addressing the staff shortage issue and their outcomes. Therefore, the main question of this study is how to create a central mechanism to allocate severely limited medical staff to healthcare centers during emergencies. METHODS For the Commonwealth of Massachusetts, we developed a mathematical programming model to match severely limited available staff with LTCF demand requests submitted through a designed portal. To find feasible matches and prioritize facility needs, we incorporated restrictions and preferences for both sides. For staff, we considered maximum mileage they are willing to travel, available by date, and short- or long-term work preferences. For LTCFs, we considered their demand quantities for different positions and the level of urgency for their demand. As a secondary goal of this study, by using the feedback entries data received from the LTCFs on their matches, we developed statistical models to determine the most salient features that induced the LTCFs to submit feedback. RESULTS We used the developed portal to complete about 150 matching sessions in 14 months to match staff to LTCFs in Massachusetts. LTCFs provided feedback for 2,542 matches including 2,064 intentions to hire the matched staff during this time. Further analysis indicated that nursing homes and facilities that entered higher levels of demand to the portal were more likely to provide feedback on the matches and facilities that were prioritized in the matching process due to whole facility testing or low staffing levels were less likely to do so. On the staffing side, matches that involved more experienced staff and staff who can work afternoons, evenings, and overnight were more likely to generate feedback from the facility that they were matched to. CONCLUSION Developing a central matching framework to match medical staff to LTCFs at the time of a public health emergency could be an efficient tool for responding to staffing shortages. Such central approaches that help allocate a severely limited resource efficiently during a public emergency can be developed and used for different resource types, as well as provide crucial demand and supply information in different regions and/or demographics.
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Affiliation(s)
- Hamid Reza Zarei
- Department of Mechanical & Industrial Engineering, Northeastern University, Boston, MA, USA.
| | | | - Ozlem Ergun
- Department of Mechanical & Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Patricia Yu
- Executive Office of Health and Human Services, Boston, MA, USA
| | - Leanne Winchester
- Graduate School of Nursing, University of MA Chan Medical School - Commonwealth Medicine, Worcester, MA, USA
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Wang XJ, Thomas KS, Belanger E, Dobbs D, Dosa DM. Hospice Aide Visits among Nursing Home Residents During the Early Months of the COVID-19 Pandemic. J Am Med Dir Assoc 2023; 24:911-916.e6. [PMID: 37146643 PMCID: PMC10067455 DOI: 10.1016/j.jamda.2023.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE Hospice aides are vital in delivering care to patients and family members at the end of life. The COVID-19 pandemic resulted in disruptions in hospice care delivery, especially in long-term care settings. We aim to provide a description of hospice aide visits among nursing home residents enrolled in hospice during the first 9 months of 2020, as compared with the same months in 2019. DESIGN Observational cohort study. SETTING AND PARTICIPANTS 153,109 and 152,077 long-stay nursing home residents enrolled in hospice in 2019 and 2020, respectively. METHODS On a monthly basis, we reported estimated probabilities of not having visits from hospice aides and adjusted visit minutes among those who had hospice aide visits for the 2019 and 2020 cohort, respectively. The regression models accounted for resident sociodemographic and clinical characteristics and nursing home fixed effects. The analyses were conducted at the national and state level, separately. RESULTS More than half of residents did not have any visits from hospice aides in 2020 from April and onward. Among residents who had hospice aide visits, the 2020 cohort had reduced visits in March and onward, with the greatest difference being 155 minutes less in April (95% CI: -163.4, -146.5). State-level analyses suggested that multiple factors besides community spread or state policies might contribute to the reduced presence of hospice aides. CONCLUSIONS AND IMPLICATIONS Our findings highlight the toll of the pandemic on hospice care delivery in nursing homes and the need for hospice care to be better incorporated into emergency preparedness planning.
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Affiliation(s)
- Xiao Joyce Wang
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA.
| | - Kali S Thomas
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Health Services, Policy, & Practice, Brown University School of Public Health, Providence, RI, USA; Providence VA Medical Center, Providence, RI, USA
| | - Emmanuelle Belanger
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Health Services, Policy, & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Debra Dobbs
- School of Aging Studies, University of South Florida, FL
| | - David M Dosa
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Providence VA Medical Center, Providence, RI, USA; Warren Alpert Medical School, RI, USA
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Booker SQ, Sowicz TJ, Knisely MR, Saravanan A, Bai J, St Marie B. Original Research: The Impact of COVID-19 on Pain Care Among Older Adults. Am J Nurs 2023; 123:26-36. [PMID: 37166166 DOI: 10.1097/01.naj.0000937180.48669.ae] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE In this qualitative descriptive study, we sought to understand the professional experiences and perceptions of pain management nurses who cared for older adults in the United States during the height of the COVID-19 pandemic. METHODS Data were collected between July 2020 and July 2021 through individual, semistructured interviews with a nonprobability sample of 18 pain management nurses. An inductive content analysis approach, in which categories were derived from a coding process based on a close reading of data extracts from the interview transcripts, was used to reveal the major theme related to the study aim. RESULTS Notwithstanding the variable consequences of COVID-19 on patients' health, a single overarching theme was pronounced: "Pain management for older adults remained unchanged during the pandemic despite unpredictable survival, restrictions on human interactions, and communication challenges." This theme was supported by four categories that emerged from the data: unpredictable survival, restriction-induced isolation, perceived continuity and equality of pain management, and communication challenges. CONCLUSIONS During the COVID-19 pandemic, pain management nurses stepped in and joined interdisciplinary teams providing general and specialized pain care to ensure that older adults, whether inpatient or outpatient, continued to receive quality care. These study findings highlight the many challenges pain management nurses faced during this unprecedented public health crisis, as well as opportunities to improve the health system and enhance nursing practice to meet the needs of older patients.
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Affiliation(s)
- Staja Q Booker
- Staja Q. Booker is an assistant professor at the University of Florida College of Nursing in Gainesville. Timothy Joseph Sowicz is an assistant professor at the University of Arizona College of Nursing in Tucson. Mitchell R. Knisely is an associate professor at the Duke University School of Nursing in Durham, NC. Anitha Saravanan is an assistant professor at Northern Illinois University School of Nursing and Health Studies in DeKalb. Jinbing Bai is an assistant professor at the Emory University Nell Hodgson Woodruff School of Nursing in Atlanta. Barbara St. Marie is an associate professor at the University of Iowa College of Nursing in Iowa City. Contact author: Staja Q. Booker, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Urlings JHJ, Backhaus R, Verbeek H, de Boer B, Koopmans RTCM, Gerritsen DL, Hamers JPH. After COVID-19 vaccinations: what does living and working in nursing homes look like? BMC Geriatr 2023; 23:298. [PMID: 37193994 PMCID: PMC10186323 DOI: 10.1186/s12877-023-03987-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 04/21/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Nursing homes were disproportionally affected by the COVID-19 pandemic. Vaccination was considered critical for the normalization of daily live of nursing home residents. The present study investigates the impact of the prolonged COVID-19 pandemic and the effect of vaccinations on the daily lives of residents and staff in Dutch nursing homes. SETTING AND PARTICIPANTS The sample consisted of 78 nursing homes that participated in the Dutch national pilot on nursing home visits after the COVID-19 pandemic. One contact person per nursing home was approached for participation in this mixed-methods cross-sectional study. METHODS Data was collected twice through questionnaires in April and December 2021. Quantitative questions focused on recent COVID-19 outbreaks, progress of vaccination, effects of vaccination on daily living in the nursing home and burden experienced by staff. Open-ended questions addressed the prolonged effect of the pandemic on residents, family members and staff. RESULTS The overall vaccination rate of residents across nursing homes appeared to be high among both residents and staff. However, daily living in the nursing home had not returned to normal concerning personal interactions, visits, the use of facilities and work pressure. Nursing homes continued to report a negative impact of the pandemic on residents, family members and staff. CONCLUSIONS Restrictions to the daily lives of residents in nursing homes were stricter than restrictions imposed on society as a whole. Returning to a normal daily living and working was found to be complex for nursing homes. With the emergence of new variants of the virus, policies strongly focusing on risk aversion were predominantly present in nursing homes.
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Affiliation(s)
- Judith H J Urlings
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Postbus 616, 6200, MD Maastricht, the Netherlands.
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands.
| | - Ramona Backhaus
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Postbus 616, 6200, MD Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Postbus 616, 6200, MD Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Bram de Boer
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Postbus 616, 6200, MD Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
- De Waalboog "Joachim en Anna", Center for Specialized Geriatric Care, Nijmegen, the Netherlands
| | - Debby L Gerritsen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jan P H Hamers
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Postbus 616, 6200, MD Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
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Joshi S. Staffing Shortages, Staffing Hours, and Resident Deaths in US Nursing Homes During the COVID-19 Pandemic. J Am Med Dir Assoc 2023:S1525-8610(23)00411-5. [PMID: 37253431 PMCID: PMC10165011 DOI: 10.1016/j.jamda.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Staffing shortages at nursing homes during the COVID-19 pandemic may have impacted care providers' staffing hours and affected residents' care and outcomes. This study examines the association of staffing shortages with staffing hours and resident deaths in nursing homes during the COVID-19 pandemic. DESIGN This study measured staffing hours per resident using payroll data and measured weekly resident deaths and staffing shortages using the Centers for Disease Control and Prevention's National Healthcare Safety Network data. Multivariate linear regressions with facility and county-week fixed effects were used to investigate the association of staffing shortages with staffing hours and resident deaths. SETTING AND PARTICIPANTS 15,212 nursing homes. MEASURES The primary outcomes included staffing hours per resident of registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs) and weekly total deaths per 100 residents. RESULTS Between May 31, 2020, and May 15, 2022, 18.4% to 33.3% of nursing homes reported staffing shortages during any week. Staffing shortages were associated with lower staffing hours per resident with a 0.009 decrease in RN hours per resident (95% CI 0.005-0.014), a 0.014 decrease in LPN hours per resident (95% CI 0.010-0.018), and a 0.050 decrease in CNA hours per resident (95% CI 0.043-0.057). These are equivalent to a 1.8%, 1.7%, and 2.4% decline, respectively. There was a positive association between staffing shortages and resident deaths with 0.068 (95% CI 0.048-0.088) total deaths per 100 residents. This was equivalent to an increase of 10.5%. CONCLUSION AND IMPLICATIONS Our results showed that self-reported staffing shortages were associated with a statistically significant decrease in staffing hours and with a statistically significant increase in resident deaths. These results suggest that addressing staffing shortages in nursing homes can save lives.
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Affiliation(s)
- Sushant Joshi
- USC Sol Price School of Public Policy, Los Angeles, CA, USA.
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Pietrantoni D, Barroca C, Lynch S, Byrne J, Ortner M, Kotwani R, Limbrick K, Kaldas P, Moussa M, Fredrickson T, Schaefer J, Jacobs RJ. A Scoping Review on the Effects of COVID-19 on Syringe Service Programs in the United States. Cureus 2023; 15:e39023. [PMID: 37378253 PMCID: PMC10292154 DOI: 10.7759/cureus.39023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/14/2023] [Indexed: 06/29/2023] Open
Abstract
The COVID-19 pandemic has had worldwide impacts, including disrupting community services. One interrupted service was syringe service programs (SSPs), community-established initiatives that provide sterile supplies and aid in overcoming addiction in drug-using participants. In the United States (U.S.), SSPs have been key in combating the recent opioid use crisis and associated infections such as the human immunodeficiency virus (HIV) and hepatitis C. While some published reports on the pandemic's overall impacts on SSPs exist, certain aspects such as operational changes and repercussions on staff and participants may still be lacking. Information about the impact of interrupted SSP services due to the pandemic may provide insight into how to prepare to mitigate similar outcomes during possible future health outbreaks. The aim of this scoping review was thus to explore the effects of the COVID-19 pandemic on the operations, staff, and participants of SSPs in the U.S. The initial search of the databases PubMed, Embase, and Web of Science with selected keywords yielded 117 articles published in English between January 1, 2020, and August 31, 2022. After screening each article for study eligibility, 11 articles were included in the final review. Of the seven articles exploring SSP operational impacts from the pandemic, five acknowledged that mitigation strategies influenced functions, seven highlighted supply changes, and four emphasized the resulting staffing changes. Four studies inspected the pandemic's impacts on SSP participants, which included two articles highlighting participants' struggles with isolation and loneliness, one referencing the fear of exposure to the SARS-CoV-2 virus, and two examining the overall negative psychological effects experienced during this time. SSPs in various settings and regions across the U.S. experienced changes due to the COVID-19 pandemic. Many of these modifications negatively impacted operations, staffing, and participant relationships. Examining the issues that individual SSPs encountered highlights opportunities for structured solutions for the present and in the case of future infectious disease outbreaks. With the severity of the opioid use crisis in the U.S. and the dependence on SSPs for its mitigation, future work in this space should be prioritized.
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Affiliation(s)
- Dylan Pietrantoni
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Crystal Barroca
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Sarah Lynch
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Jonathan Byrne
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Miranda Ortner
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Roshni Kotwani
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Kolin Limbrick
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Paul Kaldas
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Michael Moussa
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Tatem Fredrickson
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Jeffrey Schaefer
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Robin J Jacobs
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
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Yoon JM, Trinkoff AM, Kim M, Kim E. State-level nursing home in-service dementia training requirements and inappropriate psychotropic medication use. Geriatr Nurs 2023; 51:209-214. [PMID: 37011493 DOI: 10.1016/j.gerinurse.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/07/2023] [Accepted: 03/07/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Although non-pharmacological interventions, which are staff intensive, are recommended for behavioral symptoms of dementia, psychotropics are often prescribed in nursing homes (NHs), with insufficient nurse staffing levels and dementia care training. Since 2017, deficiency citations can be assigned for inappropriate psychotropics use (F-758 tag). Some states require in-service dementia training above federal minimums, but it is unknown whether extra dementia training requirements were related to fewer F-758 citations for residents with dementia and whether nurse staffing influenced the relationship between receiving F-758 citations and having additional state-level dementia training requirements. PURPOSE To relate F-758 citation occurrence to extra in-service dementia training regulations and to explore how the relationships are affected by nurse staffing levels. METHOD Generalized linear mixed models were used to examine F-758 citation occurrence in relation to state-level in-service dementia training regulations. Stratification was also conducted to compare the effects in NHs with low versus high nurse staffing. FINDINGS Requiring in-service dementia training with extra hours was inversely related to receiving F-758 tags. That relationship was also noted in NHs with lower registered nurse and certified nurse assistant staffing. DISCUSSION In-service dementia training may be helpful in reducing inappropriate psychotropics use, particularly in facilities with lower nurse staffing.
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Affiliation(s)
- Jung Min Yoon
- Ewha Womans University, College of Nursing, Seoul, South Korea.
| | | | - Miyoung Kim
- Ewha Womans University, College of Nursing, Seoul, South Korea.
| | - Eunjin Kim
- Ewha Womans University, College of Nursing, Seoul, South Korea.
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Rabilloud M, Elsensohn MH, Riche B, Voirin N, Bénet T, Porcu C, Iwaz J, Étard JF, Vanhems P, Écochard R. Stronger Impact of COVID-19 in Nursing Homes of a French Region During the Second Pandemic Wave. J Am Med Dir Assoc 2023:S1525-8610(23)00378-X. [PMID: 37156472 PMCID: PMC10121131 DOI: 10.1016/j.jamda.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/13/2023] [Accepted: 04/04/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES Quantify the effects of characteristics of nursing homes and their surroundings on the spread of COVID-19 outbreaks and assess the changes in resident protection between the first 2 waves (March 1 to July 31 and August 1 to December 31, 2020). DESIGN An observational study was carried out on data on COVID-19 outbreaks extracted from a database that monitored the spread of the virus in nursing homes. SETTING AND PARTICIPANTS The study concerned all 937 nursing homes with >10 beds in Auvergne-Rhône-Alpes region, France. METHODS The rate of nursing homes with at least 1 outbreak and the cumulative number of deaths were modeled for each wave. RESULTS During the second (vs the first wave), the proportion of nursing homes that reported at least 1 outbreak was higher (70% vs 56%) and the cumulative number of deaths more than twofold (3348 vs 1590). The outbreak rate was significantly lower in public hospital-associated nursing homes than in private for-profit ones. During the second wave, it was lower in public and private not-for-profit nursing homes than in private for-profit ones. During the first wave, the probability of outbreak and the mean number of deaths increased with the number of beds (P < .001). During the second wave, the probability of outbreak remained stable in >80-bed institutions and, under proportionality assumption, the mean number of deaths was less than expected in >100-bed institutions. The outbreak rate and the cumulative number of deaths increased significantly with the increase in the incidence of hospitalization for COVID-19 in the surrounding populations. CONCLUSIONS AND IMPLICATIONS The outbreak in the nursing homes was stronger during the second than the first wave despite better preparedness and higher availabilities of tests and protective equipment. Solutions for insufficient staffing, inadequate rooming, and suboptimal functioning should be found before future epidemics.
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Affiliation(s)
- Muriel Rabilloud
- Université de Lyon, Lyon, France; Université Lyon 1, Lyon, France; Équipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France; Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France.
| | - Mad-Hélénie Elsensohn
- Université de Lyon, Lyon, France; Université Lyon 1, Lyon, France; Équipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France; Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Benjamin Riche
- Université de Lyon, Lyon, France; Université Lyon 1, Lyon, France; Équipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France; Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Nicolas Voirin
- Epidemiology and Modelling in Infectious Diseases (EPIMOD), Dompierre-sur-Veyle, France
| | - Thomas Bénet
- Santé Publique France, Auvergne-Rhône-Alpes Regional Office, Lyon, France
| | - Catherine Porcu
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Jean Iwaz
- Université de Lyon, Lyon, France; Université Lyon 1, Lyon, France; Équipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France; Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Jean-François Étard
- TransVIHMI (Institut de Recherche pour le Développement, IRD, Institut National de la Santé et de la Recherche Médicale, INSERM, Université de Montpellier), Montpellier, France; EpiGreen, Paris, France
| | - Philippe Vanhems
- Service d'Hygiène Hospitalière, Épidémiologie, Infectiovigilance et Prévention, Hospices Civils de Lyon, Lyon, France; CIRI - Centre International de Recherche en Infectiologie, Univ Lyon, Université Claude Bernard Lyon1, Inserm, U1111, CNRS, UMR5308, ENS Lyon, Lyon, France
| | - René Écochard
- Université de Lyon, Lyon, France; Université Lyon 1, Lyon, France; Équipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France; Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
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Ulyte A, Mehrotra A, Huskamp HA, Grabowski DC, Barnett ML. Specialty care after transition to long-term care in nursing home. J Am Geriatr Soc 2023; 71:1058-1067. [PMID: 36435050 PMCID: PMC10089934 DOI: 10.1111/jgs.18129] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/20/2022] [Accepted: 10/25/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nursing home residents face many barriers to accessing specialist physician outpatient care. However, little data exists on how specialty care use changes when individuals transition to a nursing home in the US. METHODS We studied specialist outpatient visits for new long-term care (LTC) residents within 1 year before and after their transition to nursing home residence using the Minimum Data Set v3.0 (MDS) and a 20% sample of Medicare fee-for-service claims in 2014-2018. To focus on residents requiring specialty care at baseline, we limited the cohort to residents with specialty care in the 13-24 months before LTC transition. We then measured the proportion of residents receiving at least one visit in the 12 months before the transition and the 12 months after the transition. We also examined subgroups of residents with a prior diagnosis likely requiring long-term specialty care (e.g., multiple sclerosis). Finally, we examined whether there was continuity of care within the same specialty care provider. RESULTS Among 39,288 new LTC transitions identified in 2016-2017, 17,877 (45.5%) residents had a prior specialist visit 13-24 months before the transition. Among them, the proportion of residents with specialty visits decreased consistently in all specialties in the 12 months after the transition, ranging from a relative decrease of 14.4% for orthopedics to 67.9% for psychiatry. The relative decrease among patients with a diagnosis likely requiring specialty care ranged from 0.9% for neurology in patients with multiple sclerosis to 67.1% for psychiatry in patients with severe mental illness. Among residents who continued visiting a specialist, 78.9% saw the same provider as before the transition. CONCLUSIONS The use of specialty care falls significantly after patients transition to a nursing home. Further research is needed to understand what drives this drop in use and whether interventions, such as telemedicine can ameliorate potential barriers to specialty care.
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Affiliation(s)
- Agne Ulyte
- Department of Health Care Policy, Harvard Medical School
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School
- Division of General Medicine, Beth Israel Deaconess Medical Center
| | | | | | - Michael L Barnett
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital
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Bowblis JR, Akosionu O, Ng W, Shippee TP. Identifying Nursing Homes With Diverse Racial and Ethnic Resident Compositions: The Importance of Group Heterogeneity and Geographic Context. Med Care Res Rev 2023; 80:175-186. [PMID: 36408838 DOI: 10.1177/10775587221134870] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Racial/ethnic composition of nursing home (NH) plays a particularly important role in NH quality. A key methodological issue is defining when an NH serves a low versus high proportion of racially/ethnically diverse residents. Using the Minimum Data Set from 2015 merged with Certification and Survey Provider Enhanced Reports, we calculated the racial/ethnic composition of U.S.-based NHs for Black or Hispanic residents specifically, and a general Black, Indigenous, and People of Color (BIPOC) grouping for long-stay residents. We examined different definitions of having a high racial/ethnic composition by varying percentile thresholds of composition, state-specific and national thresholds, and restricting composition to BIPOC residents as well as only Black and Hispanic residents. NHs with a high racial/ethnic composition have different facility characteristics than the average NH. Based on this, we make suggestions for how to identify NHs with diverse racial/ethnic resident compositions.
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Affiliation(s)
| | | | - Weiwen Ng
- University of Minnesota, Twin Cities, Minneapolis, USA
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Shi SM, Kosar CM, Gouskova N, Berry S. Post-Acute Care Rehabilitation Services and Outcomes in Skilled Nursing Facilities Before and During the COVID-19 Pandemic. JAMA HEALTH FORUM 2023; 4:e230019. [PMID: 36867421 PMCID: PMC9984966 DOI: 10.1001/jamahealthforum.2023.0019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
This cohort study evaluates changes in rehabilitation services provided by skilled nursing facilities during the COVID-19 pandemic.
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Affiliation(s)
- Sandra M Shi
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Cyrus M Kosar
- Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Brown School of Public Health, Providence, Rhode Island
| | - Natalia Gouskova
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Sarah Berry
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
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Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains asymptomatic in 33% to 90% of older adults depending on their immune status from prior infection, vaccination, and circulating strain. Older adults symptomatic with SARS-CoV-2 often both present atypically, such as with a blunted fever response, and develop more severe disease. Early and late reports showed that older adults have increased severity of coronavirus disease 2019 (COVID-19) with higher case fatality rates and higher intensive care needs compared with younger adults. Infection and vaccine-induced antibody response and long-term effects of COVID-19 also differ in older adults.
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Chróinín DN, Anthony A, Acosta RM, Thambyaiyah D, Hasan N, Patil A. Residential Aged Care Facilities During the COVID-19 Pandemic: A Staff Survey on Impact and Resources. J Gerontol Nurs 2023; 49:13-17. [PMID: 36852986 DOI: 10.3928/00989134-20230209-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The current study explored the impact of the coronavirus disease 2019 (COVID-19) pandemic on staff in residential aged care facilities (RACFs). A hardcopy, voluntary, anonymous survey was circulated to local RACFs (June-July 2020), exploring challenges, staffing effects, mood within RACFs, and staff perceptions of supports. Overall, 105 staff members responded, which were mainly nursing personnel (67.6%) and owners/managers (10.5%). Seventy percent believed they were equipped to handle patients with COVID-19. One quarter reported personal protective equipment shortages. Respondents reported pressures to accept patients with COVID-19 from hospitals and/or keep residents in the RACF. One third reported staff "calling in sick" related to COVID-19/quarantine. Common compensatory strategies included increasing part-time workers' hours. Reported mood was largely positive. Most (86.4%) respondents felt supported by general practitioner and local geriatric outreach services. Opportunities to best support RACF staff require further research and dialogue. [Journal of Gerontological Nursing, 49(3), 13-17.].
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Muduzu L, Wei L, Cope V. Exploring Nursing Staff's Experiences and Perspectives of COVID-19 Lockdown in a Residential Aged Care Setting in Australia. J Gerontol Nurs 2023; 49:34-39. [PMID: 36852989 DOI: 10.3928/00989134-20230210-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
An exploratory qualitative study was performed to evaluate the experiences of nursing staff (N = 10) working in a residential aged care facility (RACF) during the coronavirus disease 2019 (COVID-19) pandemic lockdown. Semi-structured, in-person interviews were performed, and thematic analysis was used to analyze the data. Care staff had little or no knowledge of how to cope with a lockdown necessitated by a pandemic. However, management developed proactive plans as they aligned with the changing care circumstances and ongoing government directives. Five major themes were identified: Prolonged Use and Shortage of Personal Protective Equipment; "Blind Leading the Blind"; Communication and Teamwork; Lack of Education; and Resident Response. RACF staff described working under stressful conditions during the initial COVID-19 pandemic lockdown; yet with experience, care staff and the management team adapted to pandemic requirements to meet the needs of residents in their care. RACFs should be prepared for the impact of pandemics on staff and ensure care resources and support are available for the continuity of safe and quality care of residents. [Journal of Gerontological Nursing, 49(3), 34-39.].
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Zbyszewska A, Sekalala S. Towards a Feminist Geo-legal Ethic of Caring Within Medical Supply Chains: Lessons from Careless Supply During the COVID-19 Pandemic. FEMINIST LEGAL STUDIES 2023; 31:1-26. [PMID: 36843653 PMCID: PMC9942643 DOI: 10.1007/s10691-023-09520-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 06/18/2023]
Abstract
The COVID-19 crisis illustrates the fragility of supply chains. Countries with excellent health systems struggled to ensure essential supplies of food, medicines, and personal protective equipment which were vital to a fast and effective response. Using geo-legality, which maps the constitutive relations between law and space, we argue that the failure of supply chains in many western countries during the crisis reveals a fundamental tension between their role as facilitators of care and caring, and the logistic logics by which they operate. While supply chains link the intimate, domestic concerns of providing medical care with the globalised geographical concerns of moving goods across different jurisdictions at the right time, their contemporary organisation and regulation does not reflect the caring relations and public goods they are meant to support. Drawing on analysis of examples from Canada, the United Kingdom, and the United States, this article argues that a reconfiguration of supply chains in accordance with feminist approaches that place care at the centre of supply chain operation and organisation will be important to amendments of both domestic and global health law.
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Affiliation(s)
- Ania Zbyszewska
- Department of Law and Legal Studies, Carleton University, Ottawa, Canada
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Adams JW, Jones K, Preiss S, Hadley E, Segelman M. Evaluating Policies to Decrease the Risk of Introducing SARS-CoV-2 Infections to Nursing Home Facilities. J Appl Gerontol 2023:7334648231155873. [PMID: 36749786 PMCID: PMC10360919 DOI: 10.1177/07334648231155873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
We used an individual-based microsimulation model of North Carolina to determine what facility-level policies would result in the greatest reduction in the number of individuals with SARS-CoV-2 entering the nursing home environment from 12/15/2021 to 1/3/2022 (e.g., Omicron variant surge). On average, there were 14,287 (Credible Interval [CI]: 13,477-15,147) daily visitors and 17,168 (CI: 16,571-17,768) HCW coming from the community into 426 nursing home facilities. Policies requiring a negative rapid test or vaccinated status for visitors resulted in the greatest reduction in the number of individuals with SARS-CoV-2 infection entering the nursing home environment with a 29.6% (26.9%-32.0%) and 24.0% (CI: 22.2%-25.5%) reduction, respectively. Policies halving visits (21.2% [20.0%-28.2%]), requiring all vaccinated HCW to receive a booster (7.8% [CI: 7.4%-8.7%]), and limiting visitation to a primary visitor (6.5% [CI: 3.5%-9.7%]) reduced infectious contacts to a lesser degree.
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Affiliation(s)
| | - Kasey Jones
- 6856RTI International, Research Triangle, NC, USA
| | - Sandy Preiss
- 6856RTI International, Research Triangle, NC, USA
| | - Emily Hadley
- 6856RTI International, Research Triangle, NC, USA
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Bowblis JR, Brunt CS, Xu H, Grabowski DC. Understanding Nursing Home Spending And Staff Levels In The Context Of Recent Nursing Staff Recommendations. Health Aff (Millwood) 2023; 42:197-206. [PMID: 36745835 DOI: 10.1377/hlthaff.2022.00692] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
To provide context for evaluating proposed nursing home staff regulations, we examined the proportion of facility revenues spent on nursing staff, as well as nursing staff levels in hours worked and paid per resident day, in 2019. Nationally, the median proportion of revenues spent on nursing staff was 33.9 percent, and median nursing staff levels were 3.67 hours worked and 4.08 hours paid per resident day. Facilities with higher shares of Medicaid residents spent a larger share of revenues on nursing staff but had lower staffing levels. States varied significantly with respect to median spending on nursing staff (26.8-44.0 percent of revenues) and median nursing staff levels (3.2-5.6 hours worked and 3.6-5.7 hours paid per resident day). These findings indicate that raising the proportion of revenues spent by nursing homes on nursing staff to a regulated minimum would not guarantee the achievement of adequate nursing staff levels unless it was paired with other regulatory mechanisms.
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Affiliation(s)
| | | | - Huiwen Xu
- Huiwen Xu, University of Texas Medical Branch, Galveston, Texas
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"Because if I don't hold his hand then I might as well not be there": Experiences of Dutch and UK care home visiting during the COVID-19 pandemic. Int Psychogeriatr 2023; 35:107-116. [PMID: 35039101 DOI: 10.1017/s1041610221002799] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To explore and compare the experiences of care home visits during the pandemic in the UK and the Netherlands. DESIGN Qualitative semi-structured interview studies. SETTING AND PARTICIPANTS Family carers of relatives residing in care homes in the UK and the Netherlands were interviewed remotely. METHODS Family carers were asked about their experiences of care home visits during the pandemic, and specifically in the Netherlands after care homes had reopened. Transcripts were analyzed in each country separately in the native language using thematic analysis, before discussing findings at multiple analysis meetings. RESULTS Across 125 interviews, we developed four themes: (1) different types of contact during lockdown; (2) deterioration of resident health and well-being; (3) emotional distress of both visitors and residents; and (4) compliance to guidelines and regulations. Visiting in both the UK and the Netherlands was beneficial, if possible in the UK, yet was characterized by alternative forms of face-to-face visits which was emotionally distressing for many family carers and residents. In the Netherlands, government guidance did enable early care home visitation, while the UK was lacking any guidance leading to care homes implementing restrictions differently. CONCLUSIONS AND IMPLICATIONS Early and clear guidance, as well as communication, is required in future pandemics, and in this ongoing pandemic, to enable care home visits between residents and loved ones. It is important to take learnings from this global pandemic to reimagine long-term care, highlighting the value of socializing for care home residents.
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Wittenberg GF, Reddy A, Gifford DR, McLaughlin MM, Leung V, Baier RR. Design of a Nursing Home Infection Control Peer Coaching Program. J Am Med Dir Assoc 2023; 24:573-579. [PMID: 36708742 DOI: 10.1016/j.jamda.2022.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 12/09/2022] [Accepted: 12/27/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To pilot test and refine an infection control peer coaching program, Infection Control Amplification in Nursing Centers (ICAN), in partnership with providers. DESIGN Intervention design and pilot test. SETTING AND PARTICIPANTS Infection preventionists (IPs) from 7 Connecticut nursing homes (NHs). METHODS We codesigned and pilot tested the ICAN program with NH IPs. The initial program involved designating peer coaches to provide real-time feedback on infection control practices to coworkers and targeting coaches' observations using data from both observations shared by coaches in daily huddles and weekly audit data about hand hygiene, masking, and transmission-based precautions. IPs tested the initial program while providing feedback to the research team during weekly calls. We used information from the calls, participant surveys, and the pilot process to update the program. RESULTS Despite IPs reporting that the initial program was highly aligned with facility priorities and needs, their weekly call attendance dropped as they dealt with short staffing and COVID-19-related outbreaks and none implemented all of the program's components as intended. Most IPs described making changes to increase feasibility and reduce burden on staff amid short staffing and other ongoing issues exacerbated by the SARS-CoV-2 pandemic. We used information from the IPs and the pilot to update the program, including shifting from having IPs lead implementation solo to using a team-based approach. The updated program retains peer coaches and audit data, while broadening the mode of feedback from huddles only to communication using one-on-one meetings or emails, huddles, or other strategies. It also provides NH staff with flexibility to tailor implementation of each to their needs and constraints. CONCLUSIONS AND IMPLICATIONS Working with staff, we developed an infection control peer coaching program that may be of use to NH leaders seeking strategies to strengthen infection control practices. Future work should involve implementing and evaluating the updated program.
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Affiliation(s)
- Grace F Wittenberg
- Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, RI, USA
| | - Ann Reddy
- Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, RI, USA
| | - David R Gifford
- American Health Care Association/National Center for Assisted Living, Washington, DC, USA
| | - Marguerite M McLaughlin
- Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, RI, USA
| | - Vivian Leung
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Rosa R Baier
- Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, RI, USA; Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA.
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Kang Y, David SV, Bowblis JR, Intrator O, Downer B, Li CY, Goodwin JS, Xu H. Financial Performance is Associated With PPE Shortages in Chain-Affiliated Nursing Homes During the COVID-19 Pandemic: A Longitudinal Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231219443. [PMID: 38102846 PMCID: PMC10725134 DOI: 10.1177/00469580231219443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 11/02/2023] [Accepted: 11/20/2023] [Indexed: 12/17/2023]
Abstract
Many nursing homes operated at thin profit margins prior to the COVID-19 pandemic. This study examines the role of nursing homes' financial performance and chain affiliation in shortages of personal protection equipment (PPE) during the first year of the COVID-19 pandemic. We constructed a longitudinal file of 79 868 nursing home-week observations from 10 872 unique facilities. We found that a positive profit margin was associated with a 21.0% lower probability of reporting PPE shortages in chain-affiliated nursing homes, but not in non-chain nursing homes. Having adequate financial resources may help nursing homes address future emergencies, especially those affiliated with a multi-facility chain.
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Affiliation(s)
- Yejin Kang
- University of Texas Medical Branch, Galveston, TX, USA
| | | | | | - Orna Intrator
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- Canandaigua VA Medical Center, Canandaigua, NY, USA
| | - Brian Downer
- University of Texas Medical Branch, Galveston, TX, USA
| | - Chih-Ying Li
- University of Texas Medical Branch, Galveston, TX, USA
| | | | - Huiwen Xu
- University of Texas Medical Branch, Galveston, TX, USA
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Yaraghi N, Henfridsson O, Gopal R. Impact of the COVID-19 pandemic on staff turnover at long-term care facilities: a qualitative study. BMJ Open 2022; 12:e065123. [PMID: 36521894 PMCID: PMC9755903 DOI: 10.1136/bmjopen-2022-065123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The objective of this research was to explore the lived experiences of long-term care facilities' staff during the COVID-19 pandemic and examine if and how the pandemic played a role in their decision to leave their jobs. DESIGN Qualitative study using thematic analysis of semistructured interviews. Interview transcripts were analysed using coding techniques based in grounded theory. PARTICIPANTS A total of 29 staff with various roles across 21 long-term care facilities in 12 states were interviewed. RESULTS The pandemic influenced the staff's decision to leave their jobs in five different ways, namely: (1) It significantly increased the workload; (2) Created more physical and emotional hazards for staff; (3) Constrained the facilities and their staff financially; (4) Deteriorated morale and job satisfaction among the staff and (5) Increased concerns with upper management's commitment to both general and COVID-19-specific procedures. CONCLUSIONS Staff at long-term care facilities discussed a wide variety of reasons for their decision to quit their jobs during the pandemic. Our findings may inform efforts to reduce the rate of turnover in these facilities.
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Affiliation(s)
- Niam Yaraghi
- Miami Herbert Business School, University of Miami, Coral Gables, Florida, USA
- Center for Technology Innovation, The Brookings Institution, Washington, District of Columbia, USA
| | - Ola Henfridsson
- Miami Herbert Business School, University of Miami, Coral Gables, Florida, USA
| | - Ram Gopal
- Warwick Business School, University of Warwick, Coventry, UK
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Shuster SM, Lubben N. The uneven consequences of rapid organizational change: COVID-19 and healthcare workers. Soc Sci Med 2022; 315:115512. [PMID: 36370689 PMCID: PMC9643037 DOI: 10.1016/j.socscimed.2022.115512] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/27/2022] [Accepted: 11/03/2022] [Indexed: 11/10/2022]
Abstract
We examine the consequences of rapid organizational change on high and low-status healthcare workers (HCWs) during the COVID-19 pandemic. Drawing on 25 interviews, we found that rapid change can create a sense of social disorder by exacerbating the uncertainty brought on by the pandemic, crystallizing the lack of training to deal with crisis, and upending taken-for-granted roles and responsibilities in health infrastructures. Our work contributes to scholarship at the intersection of organizations, professions, and social studies of medicine. First, we show how organizations that must respond with rapidity, such as during a crisis, sets up workers for failure. Second, hastily made decisions can have monumental consequences in the work lives of HCWs, but with differences based on status. All HCWs had trouble with the rearrangement of tasks and roles. Low status HCWs were more likely to feel the strain of the lack of resources and direct contact with COVID-19 patients. High status HCWs were more likely to experience their autonomy undermined - in the organization and content of their work. In these contexts of rapid change, all HCWs experienced social disorder and a sense of inevitable failure, which obscured how organizations have perpetuated inequalities between high and low status workers.
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Affiliation(s)
- Stef M. Shuster
- Corresponding author. Holmes Hall E-193A, 919 E Shaw Ln, East Lansing, MI 48825
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SARS CoV-2 Infection among Health Care Workers from Different Health Care Facilities in Western Norway: A Prospective, Cross-Sectional Study. Viruses 2022; 14:v14122652. [PMID: 36560656 PMCID: PMC9784909 DOI: 10.3390/v14122652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Comparative data on COVID-19 among health care workers (HCWs) in different health care settings are scarce. This study investigated the rates of previous COVID-19 among HCWs in nursing homes, hospitals and a municipal emergency room (ER). Methods: We prospectively included 747 HCWs: 313 from nursing homes, 394 from hospitals and 40 from the ER. The diagnosis of COVID-19 was based on serological evidence of SARS-CoV-2 antibody positivity and self-reported RT-PCR positivity prior to inclusion. Information regarding age, sex and exposure to SARS-CoV-2 infection was collected. Results: A total of 4% (11/313) of nursing home HCWs and 6% (28/434) of HCWs in hospitals/the ER tested positive by serology and/or RT-PCR (p = 0.095). Fewer HCWs in nursing homes had occupational exposure to SARS-CoV-2 compared to those in hospitals/the ER (16% vs. 48%, p < 0, 001), but nursing homes had a higher proportion of HCWs with occupational exposure using partial/no PPE (56% vs. 19%, p < 0.001). Nevertheless, no significant differences in the risk for COVID-19 were found in relation to the rate of occupational exposure (p = 0.755) or use of inadequate PPE (p = 0.631). Conclusions: Despite a small sample size, the risk for COVID-19 among HCWs did not appear to be related to the type of health care facility, rates of occupational exposure or use of PPE.
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