New modeling research shows that nursing homes that share 5% of their direct care staff with other facilities are susceptible to the outbreak of infectious diseases, and high-owned buildings are even more at risk.
If more than 30% of nursing staff, including aides, spend time in at least two nursing homes, even well-proven tools such as rapid testing, vaccination, and the use of personal protective equipment, will be less effective.
Findings from public health and analytics researchers at the University of Missouri, Kansas and University of California, Davis confirm that there is a strong census at the facility and that “transmission dynamics” is amplified when residents interact with multiple staff members.
“Limiting staffing allocation across multiple nursing home facilities can significantly reduce the risk of transmission during an outbreak of infectious disease,” the researchers reported on Wednesday with BMC infections. “Dealing with issues related to inadequate wages and lack of financial incentives is the first step to strengthening employee recruitment and retention. This will reduce the general staff shortage in nursing homes and reduce the incidence of staff working in multiple facilities.”
Although they do not seek specific rules or regulations, the authors stated that the modeling scheme can be used by decision makers in future scenarios to identify “the most effective control and precautions.” They also said attempts to limit shared staff should be further researched due to the limitations and necessary “trade-offs” and the “operational flexibility” required during periods of lower occurrence risk.
Sharing and spreading illness
This model envisioned early COVID conditions, including shared rooms and visit restrictions, and examined how different levels of cross-building staff limited or restricted the spread of the disease. We also evaluated the use of COVID-era infection control measures, including final vaccines in conditions where a shared workforce existed.
It is not the first study to show that time-consuming labor in multiple skilled nursing facilities increases the risk of infection control.
In July 2020, just a few months after Covid began, Yale and UCLA researchers tracked smartphone use in nursing homes amid a pause in national visits. They found that 7% of phones that are likely to belong to staff are used in multiple nursing homes. “Stoping all these interconnections could lead to a 44% reduction in nursing home covid lawsuits,” they said.
Those researchers asked policymakers to encourage workers who pay to stay in one nursing home to limit traffic. For facilities known to share workers, they also encouraged an increase in testing at both locations, given that only one occurred.
Instead, throughout the darkest days of the pandemic, facilities have drained hundreds of thousands of full-time workers and dramatically increased the use of agents and travel nurses to ensure patient care.
Good intentions, more death
A BMC survey issued Wednesday used phone tracking forms and other public information to estimate how widely staff is shared across the US, and to better understand inequality and risks in care. While most state nursing homes shared less than 20% of workers, the “most” shared an estimated less than 10%, some states stood out because they needed to work in multiple locations.
Texas is where most workers divide their time within the building, with over 50% doing so.
After nursing homes hit a 30% shared staff mark, the impact on the illness was slowly leveled, but higher levels continued to increase the risk of death from the illness.
At a shared staff level of 5%, researchers found “relatively low values” of death hazards in sample nursing homes. At the 50% shared staff level, key measurements of death risk increased by more than 56%, and the other increased by 10% due to busyness among the two facilities.
“This is important. It has been suggested that increasing the number of shared staff will neutralize disease control and preventive measures because vaccination levels do not control the hazard ratio,” they write.
