COVID-19 Intensifies Nursing Home Workforce Challenges

COVID-19 Intensifies Nursing Home Workforce Challenges

Published: Sep 24, 2020
Publisher: Cambridge, MA: Mathematica
Associated Project

Assessing Connecticut’s Preparedness and Response to COVID-19 in Long Term Care Facilities

Time frame: 2020

Prepared for:

Connecticut Department of Public Health

Key Findings

Our research found that:

  • Staffing shortages and attrition further strained nursing homes during the pandemic. In response to low pay, poor working conditions, and the high risk of COVID-19 infection, some nurses and certified nursing assistants reportedly left the sector during this critical time when there is an increased demand for their skills and expertise.
  • To mitigate the impact of COVID-19 on staffing levels, nursing homes developed new recruitment infrastructure, while states and the federal government modified licensing and credentialing requirements and deployed nontraditional staff for surge support.
  • To retain nursing home staff and other frontline health care workers, federal, state, and local governments—as well as nursing homes—increased wages and augmented non-wage benefits such as childcare, housing, transportation assistance, and food supports.
  • Early in the outbreak, the lack of a unified testing strategy, test kits, and an approach to covering the cost of testing reportedly delayed assessment of residents and nursing home staff and hindered early understanding about the risk of COVID-19 transmission.

The COVID-19 pandemic is imposing unprecedented demands on health care facilities and on nursing homes. Nursing homes have had to quickly respond in order to suppress the threat of the virus, absorb a flood of federal and state guidance, make rapid changes in how care is delivered, and implement new guidelines to safeguard residents and workers. Mathematica conducted stakeholder interviews and a systematic policy review in June 2020 to research the impact of the COVID-19 pandemic on the nursing home workforce to better understand the challenges faced by nursing homes during the early phase of the outbreak. We sought to: (1) gather information about the impact of the COVID-19 pandemic on the nursing home workforce to better understand the challenges faced by nursing homes during the outbreak, and (2) identify federal and state policies and practices that have been implemented to address these challenges in nursing homes. To maintain adequate staffing levels, federal and state government agencies, as well as nursing homes, altered their standard policies and practices to mitigate the impact of COVID-19 on the nursing home workforce. Several states took an active role in strengthening the sector’s recruitment infrastructure to quickly engage volunteers and hire health care professionals during the pandemic. Federal and state agencies and trade associations also relaxed licensing, credentialing, and training requirements to facilitate the entry of new direct care staff into nursing homes and other health care facilities responding to increased needs. Federal relief programs, such as the Paycheck Protection Program, also provided short-term financial assistance to many small businesses, including nursing homes, to help maintain staffing levels. Further, some nursing homes revised their human resources policies to support workers who may be personally and financially impacted by COVID-19.

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