Staffing Levels and COVID‐19 Cases and Outbreaks in US Nursing Homes

Gorges, Rebecca J.; Konetzka, R. Tamara

BACKGROUND / OBJECTIVES: Nursing homes have experienced a disproportionate share of COVID‐19 cases and deaths. Early analyses indicated that baseline quality was not predictive of nursing home cases, but a more nuanced study of the role of nurse staffing is needed to target resources and better respond to future outbreaks. We seek to understand whether baseline nurse staffing is associated with the presence of COVID‐19 in nursing homes and whether staffing impacts outbreak severity. DESIGN / SETTING: We analyze CMS facility‐level data on COVID‐19 cases and deaths merged with nursing home and county characteristics. We use logistic regressions to examine the associations of staffing levels from Nursing Home Compare with the outcomes of any COVID‐19 cases and, conditional on at least one case, an outbreak (defined as confirmed cases / certified beds greater than 10% or total confirmed and suspected cases / beds greater than 20% or greater than 10 deaths). Among facilities with at least one case, we model count of deaths using hurdle negative‐binomial‐2 regressions. RESULTS: 71% of the 13,167 nursing homes that reported COVID‐19 data as of June 14 had at least one case among residents and/or staff. Of those, 27% experienced an outbreak. Higher RN hours are associated with a higher probability of experiencing any cases. However, among facilities with at least one case, higher nurse aide and total nursing hours are associated with a lower probability of experiencing an outbreak and with fewer deaths. The strongest predictor of cases and outbreaks in nursing homes is per capita cases in the county. CONCLUSIONS: Prevalence of COVID‐19 in the community remains the strongest predictor of COVID‐19 cases and deaths in nursing homes, but higher nurse aide and total nursing hours may help to contain the number of cases and deaths.