Evaluating Differences in Disaster-Related Staffing for Nursing Homes by Ownership Status

For-profit ownership has been linked to lower levels and skill composition of nursing home staffing, yet it is unclear whether disasters exacerbate these differences. We identified 914 nursing homes in Hurricane Ian's path (September 2022), of which 665 (72.8%) were for-profit. We applied a comparative interrupted time series design to compare staffing hours per resident per day (HPRPD) before and after landfall. Before the storm, for-profit facilities staffed 9% fewer total HPRPD than not-for-profits (95% confidence interval (CI) 0.87-0.95), with similar deficits in the employed (permanent staff) (0.88, 95% CI 0.83-0.93) and licensed (0.90, 95% CI 0.86-0.94) categories. Both for-profit (1.04; 95% CI 1.03-1.05) and not-for-profit facilities (1.03; 95% CI 1.02-1.04) increased total staffing in the post-disaster period, driven by employed personnel; the difference in the magnitude of their responses (1%) was not statistically significant. Baseline staffing differences may affect nursing homes' capacity to meet disaster-related needs.