Nursing homes across the US are understaffed, but minority communities have the worst – Consumer Health News


MONDAY, August 15, 2022 (HealthDay News) — Staffing shortages at nursing homes across the United States are severe in disadvantaged areas where the need may be greatest, researchers say.

The study, recently published in the Journal of the American Geriatrics Society – looked at staffing before the COVID-19 pandemic. It found that skilled clinical workers such as registered nurses (RNs) and physical therapists were in short supply in nursing homes in poorer neighborhoods, potentially putting residents’ safety at risk. These same neighborhoods are more likely to serve vulnerable populations, including racial and ethnic minorities.

Although some sectors have established minimum staffing standards to meet shortagesthat alone won’t solve care, said lead author Jasmine Travers, an assistant professor at New York University’s Rory Meyers College of Nursing.

“We need to address and invest in these neighborhoods where these nursing homes are,” she said.

This study sought to expand on existing research that examined deprivation in terms of one factor, poverty. Instead, the researchers used a measure of income, education, employment and housing disadvantage known as the area deprivation index. They did not focus on counties or ZIP codes, but on smaller areas called census blocks, each representing 600 to 3,000 residents.

“In early research we did during the pandemic, we found poor quality of care for residents of nursing homes located in severely deprived neighborhoods,” Travers said. As a result, she said, researchers realized that other disparities could be causing this problem.

For the study, investigators mapped area deprivation index scores for just over 12,600 nursing homes, including about 16% in very disadvantaged neighborhoods. They analyzed care home quality and payroll-based staffing data.

The analysis revealed significant differences in staffing by neighborhood.

For example, very disadvantaged areas had about 38% fewer physiotherapists and occupational therapists compared to affluent areas. They also had about 30% fewer registered nurses and 5% fewer certified practical nurses.

Travers said nursing homes in deprived areas could use less trained staff to provide more skilled care.

In a 100-bed facility in a very deprived neighborhood, RNs provided approximately 5.6 fewer hours of care per day compared to facilities in more affluent neighborhoods, for example.

Nursing homes in high-deprivation areas tended to be for-profit and served more black people and Medicaid recipients, the results showed.

In nursing homes with lower staffing levels, patients tend to have poorer outcomes. Travers said that can include more falls, increased use of antipsychotic and anti-anxiety medications, and higher numbers of pressure sores.

Having more skilled staff can also have a direct impact on care. The study noted that a higher ratio of registered nurses to licensed practical nurses, for example, is associated with lower infection and mortality rates.

“I think there’s an implication for the quality of care in nursing homes and other long-term care facilities,” said Regina Shih, director of the social and behavioral policy program at the RAND Corporation, a group global policy thinking.

Shih, who reviewed the study results, said it may include inadequate coverage of the types of care a registered nurse might provide. Someone in another role might not be able to deliver it.

Nationwide, more than 1.4 million people live in about 15,500 Medicare- and Medicaid-certified nursing homes, according to the US Department of Health and Human Services.

Despite minimum staffing standards, it may be more difficult to recruit and retain staff in disadvantaged neighborhoods, as workers may not want to live in areas with poorer housing, education and transportation , Travers said.

“It’s going to have a ripple effect on nursing homes when it comes to recruitment,” she said.

One solution would be to increase reimbursement for the US Centers for Medicare and Medicaid so nursing homes can increase their compensation. They should be required to use any additional funding for staffing, Travers said.

Tackling leadership and improving the home environment would make them better places to work, she added. And efforts to retain workers, such as incentives and signing bonuses, should be considered.

“Just really thinking and being careful about recruitment and retention and understanding that there is increased competition, especially now with COVID, where people can work virtually and remotely and not have to travel as often, and d ‘other jobs that are more desirable because of better benefits,’ Travers said. She noted that RNs can generally earn more in acute care settings than in nursing homes.

Shih said one solution to retaining qualified nurses is increased recognition of the hard work they do. Besides pay raises and other financial incentives, there are other ways to promote job satisfaction, she said.

For example, this could include giving nurses a role in governance programs and planning or providing childcare benefits.

“I think a lot of nurses want career paths, and so if they can see that career ladder and get credentialing programs and skills development coaching, that can help retain nurses as well,” Shih said.

More information

The White House has more on the supply quality care in nursing homes.

SOURCES: Jasmine Travers, RN, CCRN, PhD, assistant professor, New York University Rory Meyers College of Nursing, New York; Regina Shih, PhD, Director, Social and Behavioral Policy Program and Senior Policy Researcher, RAND Corporation, Santa Monica, CA; Journal of the American Geriatrics SocietyAugust 8, 2022

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