Could nursing home staffing habits spread the coronavirus?

With the elderly and many people with disabilities so vulnerable to COVID-19, every nursing home needs to do everything it reasonably can to prevent the entry or spread of the disease.

In a previous blog post, however, we discussed how 20% of U.S. nursing homes are facing severe personal protective equipment shortages or staffing shortages, or both. Furthermore, a federal ban on nursing home visits was meant to stop the spread of COVID-19 but has failed to do so. That may be because there is another source of infection: nursing home staff.

Researchers from Yale University and UCLA recently decided to find out whether nursing home staff was the factor leading to the continued spread of the disease. Right away, they realized that a key question was whether nursing home workers work in multiple facilities.

Many do. For example, NPR interviewed a certified nursing assistant from Southern California. A single full-time position isn’t enough to make ends meet, so she works 64 hours a week — at two different nursing homes.

The researchers used cellphone location data to track movement in and out of nursing homes. The idea was to see where there was crossover between staff without having to interview every certified nursing assistant or other employee in the nation. The team examined data from 30 million smartphones.

After analyzing that data, the research team created maps with the interconnections. On average, each nursing home was connected to seven other facilities through shared staff. It’s not ideal. Restricting staff to a single facility could mean a lot fewer infections, but the positions simply don’t pay well enough to allow for that restriction in reality. Moreover, there are often legal limits on the number of hours staff can work at each facility, so they can’t get extra hours from a single home.

These cross-connections do drive up infections

The researchers also found that the more workers a nursing home shares with nearby homes, the more COVID-19 infections occur among the residents.

Essentially, all the staff crossover creates a situation where an outbreak at one facility almost certainly means cross-contamination with other facilities.

What should nursing homes do?

The research team argues that limiting each worker to a single nursing home is not the answer until pay improves significantly. The lack of opportunity for additional hours could mean the job simply would not be feasible. And sending money to nursing homes won’t necessarily drive up pay.

If driving up pay isn’t an option and limiting staff to a single facility won’t work, the researchers suggest that nursing homes need to focus on the basics: infection control measures (like PPE use) and hand washing.

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