Because PBJ measures hours per resident day, facilities should understand that total hours and hours-per-resident-day can diverge significantly during periods of census decline, as occurred throughout 2020. SNF operators relying on anecdotal reports or self-reported survey data to assess staffing adequacy may be working from a materially different picture than what auditable PBJ records reflect.
We found that the total number of hours of direct care nursing declined in nursing homes during the COVID-19 pandemic, as did the average nursing home census. When we accounted for changes in census, the number of nurse staff hours per resident day remained steady or, if anything, increased slightly during the pandemic. The observed increases in staff hours per resident day were small but concentrated in nursing homes operating in counties with high COVID-19 prevalence, in nursing homes with low Medicaid census (which typically have more financial resources), and in not-for-profit nursing homes (which typically invest more in staffing).
Werner, Rachel M., and Norma B. Coe. “Nursing Home Staffing Levels Did Not Change Significantly During COVID-19.” Health Affairs, vol. 40, no. 5, 3 May 2021, https://doi.org/10.1377/hlthaff.2020.02351.
Nursing Facility Staffing Shortages During the COVID-19 Pandemic
This analysis presents the most recent national and state-level data on nursing facility-reported staff shortages and describes the Biden Administration’s new policy initiatives to address staffing and other quality issues in nursing facilities. National staff shortage trend data spans from May 2020, the first month when nursing facilities were required to report COVID-19 facility data to the CDC, through March 20, 2022, the most recent week of data available.
— KFF, April 4, 2022
Health Affairs Study Clashes with Previous Reports on Nursing Home Shortages
Without visits from caregivers, nursing home staff were forced to fill in these activities, adding tasks to their already stretched days. In addition, it is possible that although the number of hours worked remained stable, there were fewer staff members working those hours, resulting in the perception of increased shortages and burnout.
— Skilled Nursing News, May 27, 2021
Trends in nurse staff hours per resident day, a measure that accounts for the changes in nursing home census, show that nursing home staffing increased slightly between January and September 2020, as well as relative to the same period in 2019, going from 3.4 hours per resident day in January 2020 to 3.5 hours per resident day in September 2020.
— Provider Magazine, May 24, 2021
