![]() For example, holding all else constant, we would expect a facility with many part-time staff to be at higher risk than a facility providing a similar amount of care using only full-time staff because the former would be using more unique staff members. Correspondingly, the number of unique staff members entering the facility each day may be a crucial determinant of the frequency and size of COVID-19 outbreaks at SNFs. There are many places a SNF’s staff members can acquire infections outside the facility, such as their household, community, or even other SNFs where they work.( 10) Therefore, each additional staff member, even those not providing direct care, has the potential to asymptomatically introduce COVID-19 to the facility. However, this traditional lens does not account for staff as an important mechanism by which COVID-19 enters a facility. For instance, one study found that facilities with more staff were more likely to have a COVID-19 case, but conditional on having a case, SNFs with higher staffing levels were less likely to have a major outbreak than those with fewer staff.( 4) The mechanisms behind these results remain unclear.Īn important limitation of the literature on the relationship between direct-care staffing and outbreaks is that studies largely used the traditional lens that hours of staffing care per resident-day reflects quality of care and thus a facility’s potential for infection control. Multiple studies have found that higher direct care staffing levels per resident are associated with more limited COVID-19 outbreaks among residents in a facility.( 8, 9) Other evidence has added nuance to these findings, suggesting that the relationship between SNF staffing and COVID-19 spread is more complex. Nursing homes have suffered greatly during the COVID-19 pandemic.( 1) Although less than 1% of US population lives in long-term care facilities, roughly 5% of cases and nearly 32% of fatalities have been in these facilities.( 2) Because nursing homes, also known as skilled nursing facilities (SNFs), have spent much of 2020 closed to visitors, the primary way in which COVID-19 enters a nursing home is through staff.( 3– 5) Especially given widespread shortages of personal protective equipment and poor availability of rapid testing for SNF staff,( 6, 7) if COVID-19 is in the community where staff live, it is soon to be in the nursing home where they work. Reducing the number of unique staff members without decreasing direct-care hours, such as by relying on full-time rather than part-time staff, could help prevent outbreaks. Conventional staffing quality measures, including direct care staff to resident ratios and skill mix, were not significant predictors of COVID-19 cases or deaths. Staff size, including staff not involved in resident care, was strongly associated with SNFs’ COVID-19 outcomes, even after accounting for facility size. By the end of September 2020, sample SNFs in the lowest quartile of staff size had 6.2 resident cases and 0.9 deaths per 100 beds compared to 11.9 resident cases and 2.1 deaths per 100 beds among facilities in the highest quartile. ![]() We used detailed staffing data to examine the relationship between a novel measure of staff size (i.e., number of unique employees working daily), conventional measures of staffing quality, and COVID-19 outcomes among SNFs without confirmed COVID-19 cases by June 2020. Staff in skilled nursing facilities (SNFs) are essential health care workers, yet they can also be a source of COVID-19 transmission. Reducing the number of unique staff members without decreasing direct care hours, such as by relying on full-time rather than part-time staff, could help prevent outbreaks. Conventional staffing quality measures, including direct care staff-to-resident ratios and skill mix, were not significant predictors of COVID-19 cases or deaths. Staff size, including staff members not involved in resident care, was strongly associated with SNFs' COVID-19 outcomes, even after facility size was accounted for. By the end of September 2020, sample SNFs in the lowest quartile of staff size had 6.2 resident cases and 0.9 deaths per 100 beds, compared with 11.9 resident cases and 2.1 deaths per 100 beds among facilities in the highest quartile. We used detailed staffing data to examine the relationship between a novel measure of staff size (that is, the number of unique employees working daily), conventional measures of staffing quality, and COVID-19 outcomes among SNFs in the United States without confirmed COVID-19 cases by June 2020.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |