Immunity Increased Unsafe Staffing

During the COVID-19 pandemic, with an anticipated rise in suits over negligent care, 86% of US states hurriedly passed legislation to provide nursing homes with immunity from these cases. South Carolina was among these states, and the effects of such misguided legislation have had devastating results for care. A recent UCLA-led study revealed that nursing home staffs were reduced in states where legislatures passed immunity protections for COVID related lawsuits.

Data collected from 13,205 skilled nursing facilities from 2018 to 2023. The information analyzed was provided by two data systems operated by the Centers for Medicare and Medicaid Services (CMS): the Nursing Home Compare (NHC) quality initiative and the Payroll Based Journal Daily Nurse Staffing dataset. The findings showed that staffing was reduced by 2.5 percent in states that passed protections for nursing homes compared with states that did not pass similar legislation. “That reduction translated to an average of almost 8 hours per day of staff conducting clinical care and other duties per nursing home,” said Gretchen McCartney, who writes for UCLA Health.

“During the pandemic there was a lot of understaffing. It was even worse in these states with immunity from lawsuits,” said Jill Horwitz, an Emerita Professor of Law at the UCLA School of Law, where she began the research published June 1 in the Journal of the American Medical Association (JAMA). She also is an expert on health policy and continued to work on the study at Northwestern University’s law and medical schools, where she is now based.

While the wave of legislation did not set staffing limits or monetary awards, the effect on skilled nursing staff, specifically Certified Nursing Assistants (CNAs), was pronounced.

“Relaxing medical liability results in a worse staffing environment,” said Dr. David S. Zingmond, a corresponding author of the study and professor-in-residence at the UCLA David Geffen School of Medicine’s Division of General Internal Medicine and Health Services Research. “Lower staffing negatively impacts care, and nursing home residents are among the most vulnerable patients.”

Safety from suits alleging malpractice and neglect likely emboldened nursing homes’ callousness towards their residents. In states that passed the harmful immunity legislation, nursing homes became less likely to hire staff or attempt to find replacements during shortages. With such drastic reductions in staff, the care provided during the pandemic worsened.

“Relaxing medical liability results in a worse staffing environment,” Zingmond said. “Lower staffing negatively impacts care, and nursing home residents are among the most vulnerable patients.”

The JAMA study did not assess the impact of immunity legislation on clinical outcomes. Given what we know about the detrimental effect these laws have had on patient treatment, however, residents of these states should be gravely concerned.