Lessons Learned?

The Christian Science Monitor had an interesting article asking how nursing homes could have handled the pandemic better. What lessons were learned? The question is whether nursing homes could have done better – and can do better going forward. Only with better and safer staffing. The bottom line is that nursing homes that have worse staffing have more extensive outbreaks.

Studies in Connecticut and California found that facilities employing more registered nurses did better at keeping their residents safe. The findings are consistent with other cross-state studies, which have also found that inadequate nursing staffing, including RNs, was a factor in COVID-19 outbreaks. This is also true to prevent falls, abuse, weight loss, and pressure ulcers.  This has been well-known in the industry for years.

RNs are vital because they are the “top dogs” in facilities who train and supervise direct caregivers. They are also in charge of infection control and for assessing residents.  Decades of research shows that higher nursing staffing improves quality of care. Higher RN staffing is associated with decreased infections and other positive indicators.

Obviously, lack of PPE, poor communication, and insufficient testing supplies exacerbated the staffing issues. However, experts say that nursing levels – and particularly RN levels – can have an important effect. Having a “strong RN, trained in up-to-date protocols” meant a facility was better prepared to respond, says Ms. Howell, the ombudsman in Northern California. “It matters what you do from there.”

Federal law only mandates one registered nurse to be present at nursing facilities eight consecutive hours per day but the standard is to have “sufficient” numbers to meet the residents’ needs. However, there are no federal minimum levels of hours per patient days or for the ratio of RNs per resident. This will need to change in the future. 4.1 can be done!