A new brief recommends policies and practices aimed at improving and stabilizing staffing in nursing homes located in severely disadvantaged communities.
A new policy brief released in January by the LeadingAge LTSS Center @UMass Boston explores how levels of deprivation in a variety of neighborhoods have affected staffing levels in nursing homes located in those neighborhoods.
Neighborhood Deprivation and Nursing Home Staffing: Lessons for Policy and Practice was written by LTSS Center Co-Director Robyn Stone; Jasmine Travers, assistant professor of nursing at New York University; and Jason Falvey, assistant professor of physical therapy and rehabilitation science at the University of Maryland. The Patrick and Catherine Weldon Donaghue Medical Research Foundation funded the research.
“Maintaining staffing levels is a challenge for all nursing homes, particularly since the COVID-19 pandemic began,” write the authors. “However, research suggests that there are striking staffing disparities in nursing homes throughout the nation, with staffing shortages disproportionately affecting older adults who belong to racial and ethnic minoritized groups and economically disadvantaged populations.”
Researchers sought to find out how these disparities might be influenced by neighborhood context or the socioeconomic factors in neighborhoods where nursing homes are located. To fill this information gap, they analyzed data from the Area Deprivation Index (ADI), a measure of neighborhood socioeconomic disadvantage at the census block group level that is linked with publicly available nursing home quality and staffing data at the care-setting level.
STUDY FINDINGS
After mapping the ADI scores for 12,609 U.S. nursing homes, researchers found that nursing homes located in severely deprived areas:
- Serve a higher proportion of Black residents and are more likely to be located in rural areas.
- Are staffed for fewer hours by clinical workers like registered nurses (RN) and physical therapists, compared with nursing homes in less disadvantaged areas.
- Are more likely to substitute care traditionally provided by RNs with care provided by staff with less training. This practice raises concerns about quality of care.
POLICY RECOMMENDATIONS
Study findings suggest the need for specific policies and practices aimed at improving and stabilizing nurse staffing in nursing homes located in severely disadvantaged communities, according to the brief.
Researchers recommend that policymakers:
- Geographically micro-target policy interventions or enhanced Medicare and Medicaid reimbursements to nursing homes with the most pronounced staffing disparities.
- Fund workforce enhancement programs that provide funding to vulnerable nursing homes in inner cities and rural areas.
- Improve access to transportation to help nursing homes recruit staff.
- Establish a National Service Corps for RNs willing to work in nursing homes located in severely disadvantaged neighborhoods.
- Take nursing home disparities in severely deprived areas into account before implementing stricter staffing regulations. These regulations could inadvertently widen disparities by placing undue pressures on these nursing homes, write the authors.
Researchers recommended that nursing homes:
- Create a supportive work environment to help them attract and retain RNs, certified nursing assistants, and other clinical staff.
- Collaborate with local educators to provide high-quality clinical placements for nursing students.
- Take steps to grow their own clinical staff by offering access to career ladders and lattices.
READ THE FULL REPORT
Find out more about this study by reading Neighborhood Deprivation and Nursing Home Staffing: Lessons for Policy and Practice.