In the May issue of Health Affairs, a new study of government data show nursing home staffing levels during the COVID-19 pandemic held steady or actually increased, dispelling at least in part prior research and coverage in the media that staffing hours declined during the crisis.

In “Nursing Home Staffing Levels Did Not Change Significantly During COVID-19,” report authors said an examination of staffing hours during the first nine months of 2020 (compared with the same period in 2019) used auditable daily payroll-based staffing data from the Centers for Medicare and Medicaid Services (CMS) to show a different story.

“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 authors said.

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, and in not-for-profit nursing homes, the report said.

Across 14,554 U.S. nursing homes, average nursing home resident census began to decline in March 2020. By the end of September 2020, nursing home census had declined an average of nine residents per nursing home, going from an average of 86 residents in January 2020 to 77 residents in September 2020, for a drop of 10.5 percent, the report said.

“In comparison, during the same period in 2019, nursing home census increased by 0.3 residents, or 0.3 percent. The average total number of nurse staff hours per day in nursing homes also dropped between January and September 2020, going from 291 hours down to 262 hours, for a decline of 28.4 hours or a relative decline of 9.8 percent.”

The report said in 2019 there was a small decrease in staff hours of one hour, or 0.3 percent, during the same period.

“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,” the data show.

“This translates to an absolute increase of 5.7 minutes per resident day and a relative increase of 2.8 percent. The changes in staffing were small and similar in absolute terms across registered nurses, licensed practical nurses, and certified nurse assistants (ranging from a decrease of 0.5 minutes per resident day for certified nurse assistants to an increase of 3.2 minutes per resident day for licensed practical nurses).”

The findings may be of comfort to residents and their families but should not be seen in the light of the costs of the pandemic in terms of lives lost and ability of family members to visit their loved ones, the authors noted.

In the end, the report said the nursing home staff overcame intense challenges to perform their duties. “Staff members were putting themselves at risk providing intense and personal care to residents, often without adequate PPE [protective personal equipment] and while mourning the loss of residents they had known and cared for,” the report said.

While the vaccine programs for nursing home residents and staff have been a needed priority, the authors said policies should also focus on increasing support to nursing homes and their staff.

The report’s authors are Rachel Werner, a professor of medicine at the Perelman School of Medicine and executive director of the Leonard Davis Institute of Health Economics, University of Pennsylvania; and Norma Coe, associate professor in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania.

Read the report at