Nursing Homes Struggled with Maintaining Staffing and Disparities Widened During the First Year of the COVID-19 Pandemic

Nursing homes have historically struggled to maintain adequate nurse staffing. We analyzed Payroll Based Journal data linked to other publicly available sources and conducted interviews to understand changes in nurse staffing between 2019 and 2020. We found large declines in total staffing hours, but slight increases in staffing measured as hours per resident day (HPRD). Staffing was nonetheless a major challenge for nursing homes because they required increased staffing due to the impact of the pandemic. Nursing homes in higher quartiles of percentage of racial/ethnic minority residents served lost more nurse staffing HPRD relative to nursing homes in the lowest quartile of minority residents. Mitigating disparities between nursing homes is central to strengthening the workforce and improving care delivered in nursing homes. Policymakers may consider policies to address the outcome disparities resulting from COVID-19 by considering more targeted resources to nursing homes in underserved areas where these health disparities are more prominent.