The Impact of the COVID-19 Pandemic on the Long-Term Care Workforce

Research Objective The objective of this research was (1) to gather information about the impact of the COVID-19 pandemic on the nursing home workforce to better understand the challenges faced by nursing homes during the early phase of the outbreak, and (2) to identify new federal and state policies and practices that have been implemented to address these challenges in nursing homes. We sought to understand the challenges nursing homes faced during the early phase of the pandemic with regard to personal protective equipment (PPE), supplies for staff and infection-control policies and procedures, as well as the ability to maintain sufficient staffing levels and manage staff turnover. Study Design We conducted telephone interviews with nine key stakeholders knowledgeable about nursing home responses to the pandemic. We also conducted a systematic policy review to document federal, state, and local laws and policies designed to support nursing homes during and after the COVID-19 pandemic, with a focus on workforce challenges. Population Studied Interview respondents included researchers and national association leaders representing the nursing home industry, direct care staff, and involved in long-term care policy and practice. Principal Findings Staffing shortages and attrition due to the pandemic intensified nursing home workforce problems during the pandemic. In response to low pay, poor working conditions, and the high risk of COVID-19 infection, some nurses and certified nursing assistants left their jobs despite increased demand for their skills and expertise. The nursing home workforce also confronted new challenges during the pandemic that stemmed from a lack of critical resources, such as childcare coverage and mental health support, which escalated critical shortages of staff. The lack of a unified national testing strategy, distribution of test kits, and policies to cover cost, reportedly delayed timely testing of residents and nursing home staff early on, and hindered understanding about the risk of COVID-19 transmission. Conclusions To fill vacancies and provide surge support, nursing homes developed strategies to recruit new staff, while states and the federal government modified licensing and credentialing requirements and deployed nontraditional staff. Governments and nursing homes also increased wages and augmented non-wage benefits such as childcare, housing, transportation assistance, and food supports. Federal and state governments also increased access to PPE, expanded use of telehealth, created non-punitive leave policies, and monitored staff for illness. Implications for Policy or Practice The findings from this study point to several opportunities for further research, including examining how nursing homes have taken advantage of state and federal initiatives implemented in response to COVID-19;assessing which resources have directly impacted the capacity of the nursing home workforce;and understanding any long-lasting effects on the workforce that will remain as a result of the pandemic. It may also be informative to explore the long-term effects of the outbreak on the nursing home workforce, as the prolonged physical and emotional toll of these direct-care jobs leave the workforce prone to burnout and fatigue. Primary Funding Source DHHS Assistant Secretary for Research and Evaluation.