Staffing is a perennial challenge for all healthcare institutions , but it is particularly difficult in long-term care , where turnover rates for nursing homes range from 55 %
to 75 %, and
CNAs having turnover rates which in some cases are
nearly 100 %.
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● F0580 Notify of Changes ( Injury / Decline / Room , etc .)
● F0883 Influenza and Pneumococcal Immunizations
● F0885 Reporting – Residents , Representatives & Families
● F0686 Treatment / Services to Prevent / Heal Pressure Ulcers
● F0609 Reporting of Alleged Violations
One of the issues that became critical during the pandemic was the importance of routine , robust cleaning and disinfection in LTC facilities for the prevention of HAIs . In their site visits at 23 out of the 45 LTC facilities which reported COVID-19 infections , Telford , et al . ( 2020 ) found that overall , IP & C implementation was lowest in the disinfection category ( 33 percent ) and highest in the screening category ( 75 percent ). In the disinfection category , 61 percent of LTC facilities had a certified IP on staff and 26 percent were training and auditing staff on the proper use of cleaning products , including wet times and implementation of the two-step method . Cleaning logs documenting disinfection of shared items ( IV polls , wheelchairs , shared blood pressure cuffs ) were only present in 13 percent of LTC facilities . In the hand hygiene category , only 39 percent of LTC facilities had hand sanitizer available in all essential locations ( nursing stations , medical carts , outside COVID units , in patient rooms ). Protocols to enforce social distancing in small , enclosed spaces such as elevators or PPE donning and doffing rooms were established in 35 percent of LTC facilities . No nursing homes were implementing the Buddy System for donning and doffing PPE at the time of the researchers ’ site visits , which necessitates nursing staff observing each other through the PPE donning and doffing process .
Administrative and Staffing Challenges
Staffing is a perennial challenge for all healthcare institutions , but it is particularly difficult in long-term care , where turnover rates for nursing homes range from 55 percent to 75 percent , and CNAs having turnover rates which in some cases are nearly 100 percent . Retaining quality charge nurses is no less challenging , and now , with mandates for an infection preventionist , administrators are rethinking their workforce strategies .
As Grabowski ( 2019 ) affirms , “ Labor is the dominant input into the production of nursing home care , accounting for roughly two-thirds of nursing home expenditures . Nursing homes are predominantly staffed by registered nurses ( RNs ), licensed practical nurses ( LPNs ) and certified nursing assistants ( CNAs ). Higher nursing home staffing has generally been found to be associated with better quality of care . Nursing homes with low staffing levels , especially low RN levels , tend to have higher rates of poor resident outcomes such as pressure ulcers , catheterization , lost ability to perform daily living activities , and depression . Staffing standards may also improve working conditions , which would increase job satisfaction and reduce nursing turnover and burnout . Nursing home staff , especially
CNAs , have very high turnover . It is not uncommon for nursing homes to have their entire set of CNAs change multiple times within a calendar year . Research has found that nursing homes with higher staff turnover have worse quality .”
The 2013 Commission on Long-Term Care emphasized that , “ Nursing homes are hampered by too few staff , who are paid too little for physically and emotionally taxing work . Additionally , little room exists for these professionals to advance in their careers , and they suffer from a lack of meaningful benefits . As a result , challenges in workforce recruitment and retention are compounded year-over-year , as workforce shortages persist with the older population increasing . Without qualified staff , nursing homes find it difficult to meet residents ’ regular needs — let alone those that arise in times of crisis . Along with shortages in the workforce , some nursing home owners and administrators are limited in the resources at their disposal — hampering responses to emergencies regardless of whether they are natural disasters or infectious disease outbreaks . When crises arise , owners and administrators frequently do not have necessary training , equipment , or staff to respond . Often , nursing homes may be deemed lower-priority facilities for assistance from government sources in comparison to acute care settings . As a result , emergencies stress an already precarious care system .” ( Coronavirus Commission on Safety and Quality in Nursing Homes , 2020 )
Fiscal Challenges
Long-term care is big business . Annual U . S . spending in 2018 on nursing homes was approximately $ 170 billion , with Medicare spending approximately $ 38 billion and Medicaid spending approximately $ 50 billion ( CMS , 2019 ). What is important to remember is that long-term care facilities are paid under several different systems , and that these fragmented funding streams feature widely varying rates and myriad regulations . Some long-term care residents will stay less than 100 days , the point at which Medicare nursing home benefits generally end . These shortstay patients receive skilled nursing care , generally for either rehabilitation services after hospitalization or for palliative and hospice care at the end of life . Many more who reside in nursing homes for long periods have exhausted personal assets and rely on Medicaid for payment .
Experts agree widely that COVID-19 has exposed longstanding issues in how nursing home services are structured and financed , accounting for the perennial struggles to provide quality outcomes .
As Grabowski ( 2019 ) observes , “ The way in which we regulate and oversee care quality , how we pay for nursing home services , how we regulate the supply of providers , and the inability of many residents to oversee and monitor their care all may contribute to low quality . When it comes to nursing home care , as the old saying goes , we get what we pay for . Due