The tool uses existing evidence to form recommendations for staffing ratios in long-term care, acute and ambulatory care settings. All of the recommendations are based on key risk factors.

“We are excited to provide this tool to the infection prevention field,” Patricia Jackson, RN, president of APIC, said in a statement. “APIC members have been asking for a resource to help quantify staffing needs for years, and now we can begin to deliver on that promise. With member input, we will be able to provide a robust, accurate staffing tool that will help IP leaders make the case for adequate staff and resources to protect patients.”

The introductory version of the staffing calculator is an “exploratory approach,” APIC says. That is, it’s intended to provide a basic calculation of staffing needs and will collect data that can be used for creating a more rigorous algorithm in the future. 

Data gathered from healthcare facilities that use the tool will be utilized to update it so the tool improves over time. In the next year, an updated version will be released to reflect the accumulated data. In addition to updating the tool as it rolls out, APIC said that it will produce annual reports summarizing data to drive deeper insights into its effectiveness.

The news comes as more organizations are hiring chief infection prevention officers (CIPOs). An article published Dec. 7 in Infection Control Today shared details on this executive role that supports operational positions through the lens of preventing infection.

“Four more years” is the kind of boisterous campaign chant that punctuates the end of political rallies, with riled up fans going hoarse with the idea of sustained success.

But the American Health Care Association changed that connotation Monday with its latest projections on workforce recovery.

Instead of a joyful refrain, “four more years” could be a nursing home death knell for some facilities.

At the current hiring pace, it will take until 2026 for providers to recapture all of the workers they’ve lost since the beginning of the pandemic.

Anyone who works in skilled nursing knows recruitment continues to be a slog. That’s the way Sabra Health Care REIT CEO Rick Matros categorized it just last week, when analysts quizzed him about ongoing workforce pressures in an earnings call.

Now, a slog doesn’t sound fun necessarily, but it feels like something one can work through. 

What nursing homes face may be more difficult than a trudge through knee-deep mud. How many nursing home caregivers have it in them to continue picking up extra shifts, taking on extra daily tasks and skipping hard-earned vacations? For how long?

For many weary workers, another four years of being overworked might just prove to be an impossible, untenable ask.

Next week, we’ll be reporting on the fourth annual McKnight’s Mood of the Market survey. While I can’t spoil the story here, let’s just say some of the results are funereal, workers’ frustration all too real.

None of us can really ignore the impacts of super low unemployment in our daily lives, which has led to long lines at most stores, shorter hours at many, and crummy service all around.

But if you work in a nursing home or need to move a loved one into one, you can’t escape it. Too many facilities continue to limit admissions or close outright because they can’t find staff to meet basic care minimums safely.

And that’s exactly why AHCA President Mark Parkinson beseeched the federal government to play a larger role (and do it quickly) in “addressing the root causes of the staffing challenges in nursing homes” and developing comprehensive, long-term fixes.

The idea is that the right kind of strategic help could shorten the window of misery.

“The long-term care workforce needs a boost now,” he said Monday. “We urge federal and state policymakers to put their support behind policies that attract and retain caregivers for our nation’s seniors.”

While some of the experts I’ve spoken with in the past week are surprised that so many nursing home workers still seem prepared to leave their jobs — or the sector all together — others think continued turnover will continue leading to continued turnover.

Until someone finds a way to stem the tide, job dissatisfaction will continue to mount. Workers won’t be lining up their friends for open positions, not if they want to keep them anyway.

Without funding and regulatory policies that acknowledge the challenges, we’ll be lucky if skilled nursing facilities can keep pace with the few thousand jobs they’ve been adding monthly.

If that slows or begins to fall off again, four more years could easily become five or more. And that’s a campaign no one wants to endorse.

Kimberly Marselas is senior editor of McKnight’s Long-Term Care News.

Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.

Investigators examined data from a sample of 292 units across 86 Swiss nursing homes to gauge the impact of surveillance technology and staff opinions on appropriateness of restraints such as bed rails, trunk fixation or seating options that prevent standing. 

The researchers theorized that surveillance technologies could help to reduce and replace more restrictive forms of restraints, such as belts, to allow residents to be more safely autonomous. But their theory was not supported by the evidence. Fully 11% of residents across all of the participating facilities were physically restrained, they found, and there was no significant link between use of restraints and the prevalence of surveillance technology. 

The value of staff opinions

The findings did show, however, that residents were more likely to be restrained when staff members reported inappropriate use of physical restraints. These results suggest not only that staff is aware when restraints are overused, but that staff members’ opinions may be a valuable source of information in efforts to reduce overuse of these safety tools, the authors wrote.

In the United States, the use of surveillance technologies such as cameras in nursing homes is increasing, and some think the technology will reduce the use of restraints, the authors reported. However, “these developments are not evidence-based, and this study does not support the use of such technology to reduce restraints,” they concluded.

The study was published in the Journal of the American Geriatrics Society.

Related articles:

Physical restraints in nursing facilities; a how-to from an expert

Telemedicine linked to fewer hospital transfers and reduced restraints use in LTC during pandemic

The proposed Influenza Vaccination Coverage among Healthcare Personnel measure already exists as a Centers for Disease Control and Prevention measure for reporting on vaccination uptake in healthcare workers. If adopted for skilled nursing facilities, facilities would report data through the CDC National Healthcare Safety Network. An initial data submission period would run from Oct. 1, 2022, through March 31, 2023.

Influenza coverage low

Residents are known to be at high risk of contracting influenza and healthcare staff can be a vector for spreading the illness. There is a relatively low level of vaccination among nursing home staff when compared with other U.S. healthcare personnel overall. Tracking the number of vaccinated staff members could help to increase vaccination rates and keep residents safe, CMS stated in a fact sheet released Monday.

“[W]e believe the proposed measure has the potential to increase influenza vaccination coverage in SNFs, promote patient safety and increase the transparency of quality of care in the SNF setting,” it stated. 

The flu vaccine tracking proposal is included as part of the agency’s SNF Quality Reporting Program under a newly announced, proposed rule that would update Medicare payment policies and rates for skilled nursing facilities for fiscal year 2023.

Staff flu vax stats

In the 2020-2021 flu season, approximately 66% of healthcare workers in long-term care facilities received a flu vaccination (home healthcare personnel were included in that estimate). This compares to 76% of  healthcare personnel overall, according to the CDC.

Nursing home residents, meanwhile, had 71% vaccination coverage for the same season, according to CMS Minimum Data Set reporting.

Related articles:

CMS details on staff, possible surveyor vaccine mandates looming

Flu shot and a COVID jab? New 2021-2022 flu vaccine guidance points to both

Yearly flu vaccination does not affect SNF resident mortality in large Medicare study

Improved staff flu vaccination rates benefit everyone in LTC

The report, citing recently released data from the Centers for Disease Control and Prevention, found that 67 COVID-related deaths occurred among nursing home staff in the week ending Jan. 9. The all-time high of 69 was set in July 2020, six months before vaccines became available.

Overall, nursing homes throughout the country have experienced an alarming spike in new COVID cases in recent weeks due to community spread among the general population. Last week, 32,061 nursing home residents tested positive for COVID-19 – nearly doubling the previous week’s numbers. Staff case counts hit their highest ever last week, reaching 57,253 – more than double the previous staff case count record, set in December of 2020.

“As soon as news of Omicron broke in December, we were very concerned this variant would lead to a surge of cases in the U.S. and therefore, an increase in cases in nursing homes and unfortunately it has,” said Mark Parkinson, President and CEO of AHCA/NCAL.

Experts have repeatedly noted that COVID-19 cases in a surrounding community is a key indicator of outbreaks in nursing homes. 

“We cannot weather this storm alone,” said David Gifford, M.D., MPH, chief medical officer for AHCA/NCAL. “We’re extremely concerned how this surge will impact our already dire labor crisis as caregivers must isolate if they test positive. Staffing shortages impact access to care for our vulnerable residents and impede our ability to help overwhelmed hospitals.” 

The nursing home workforce is already experiencing a historic workforce shortage, with 234,000 fewer caregivers than when the pandemic began—a 15% reduction. 

One bright spot in the report: While COVID-related deaths among nursing home residents have increased in recent weeks, the rate of deaths is 10 times less compared to December 2020 due to high vaccination and improving booster rates among residents. 

“Fortunately, the vaccines appear to be working against omicron, but we must remain vigilant and steadfast on vaccinating and boosting as many residents and staff members as quickly as possible,” Gifford said.

A people-oriented work environment with tangible staff supports is key to minimizing turnover and care disruptions in nursing homes. In fact, direct care providers say it’s often more important than compensation, according to a new study.

Researchers from the University of Michigan and the Department of Veterans Affairs at Ann Arbor Healthcare System interviewed direct care RNs, LPNs and CNAs, as well as residents’ family members about strategies for reducing staff attrition and its consequences.

Person- and resident-centered care has been a core nursing home concept for two decades, but the study results showed that staffing problems work against this ideal, lead author Sarah L. Krein, Ph.D., RN., reported. 

“Although better wages were mentioned, it was not viewed by most participants as a primary factor to reduce turnover,” Krein said. “Rather, family members as well as direct care and administrative staff all identified the need for staff to feel appreciated and have the support they require as critical to decrease turnover and minimize disruptions in care delivery.”

“[W]hile some interviewees mentioned bonuses or incentives, it was generally in the context of staff recognition or appreciation rather than as additional compensation,” Klein added.

Direct care workers in the study talked about the importance of work environments in motivating staff to remain on the job. 

“I don’t think that a wage increase, too much, would affect the turnover,” one direct care worker said. “… I mean, higher pay could be a motivator for some, but I know most would rather prefer a better work environment.”

Another direct care worker pinpointed constant overwork and scattered support from senior care providers as an important issue:  “[If] you’re burning the candle at both ends because you’re always short-staffed … you don’t get any help from the nurse, then … and it’s just like that constantly, I mean, the money’s not worth it.”  

Administrative staff were on the same page as their direct care colleagues. As one administrator said: “So management plays a huge role in turnover, and it’s about having a rapport and, you know, respectful relationship amongst each other … So when you feel like that your boss has your back, you know, you’re more likely to stay where you’re at.”

Study respondents also offered ideas for alleviating the well-known consequence of high staff turnover rates: inconsistent care provision. New staff training and adequate training time is key to solving this problem, they said. 

New staff must get to know the resident as a person, including likes, dislikes and preferences, they said. Many family members recommended that facilities post signs in residents’ rooms to communicate preferences or specific care requirements to direct care providers, for example.

Full findings with additional suggestions from study participants were published in JAMDA.

Staff vaccination mandates for nursing home facilities are having their intended effect, protecting residents and staff from unnecessary illness and death, the results of a new analysis of federal data suggest.

Using public files representing 81% of U.S. facilities, investigators compared case rate and mortality outcomes between facilities with low and high staff vaccination coverage. Facilities were grouped according to county-level COVID-19 prevalence between June 13 and August 22, 2021. 

Many more nursing home residents became ill or died from COVID-19 in counties where staff vaccination rates were lowest when compared to counties with the highest rates — especially in COVID-19 hot spots, found the investigators, a team of public policy and long-term care experts.

In counties where COVID-19 prevalence was highest and staff vaccination rates lowest, resident deaths were 195% higher than they would have been if all the facilities had had high vaccination coverage, investigators estimated. Resident and staff case rates were similarly high in this comparison.

700 resident deaths prevented in two months

Estimates also revealed that if this large sample of U.S. nursing homes had averaged 83% staff vaccination coverage, at least 700 fewer residents would have died from COVID-19 over the two-month study period, reported study lead Brian E. McGarry, P.T., Ph.D., of the University of Rochester.

What’s more, 4,775 cases among residents and 7,501 cases among staff could possibly have been prevented, he and his colleagues added.

“These findings show the extent to which staff vaccination protects nursing home residents, particularly in communities with high COVID-19 transmission,” they wrote.

Nursing home staff are thought to be a key source of COVID-19 transmission in nursing homes. In response to a surge of resident cases due to the delta variant this summer, the Centers for Medicare & Medicaid Services has required that long-term care staff be fully vaccinated against COVID-19 by Jan. 4. 

Data for the new analysis was sourced mainly from the Centers for Medicare & Medicaid Services COVID-19 Nursing Home Public File database. 

Results were published in the New England Journal of Medicine.