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Nursing Home Staffing Struggles Add to Health Disparity in Disadvantaged Communities

Analysis  |  By Jasmyne Ray  
   August 19, 2022

The significant difference in the staffing of clinical workers in disadvantaged areas can affect the quality of care residents receive.

Clinical workers for nursing homes in disadvantaged areas are "staffed for fewer hours" compared to those in other areas, new research published by the Journal of American Geriatrics Society shows.

Much like other areas of the healthcare industry, staffing shortages have made maintaining the rate and quality of regular operations difficult. The pandemic further aggravated the shortage, with nursing homes being heavily affected.

Lack of access to care in any area contributes to health disparities in a community. A disparity like this can have negative effects on patient safety and health.

"Most skilled nursing facilities are already concerned about low staff-to-resident ratios," Jasmine Travers, PhD, MHS, AGPCNP-BC, RN, senior author of the study, said in a statement.

For their research, Travers and her colleagues from New York University mapped the deprivation index scores of different neighborhoods, looking at the income, education, and employment of their residents, as well as housing. Then, taking the deprivation index scores of 12,069 nursing homes in the nation, the researchers analyzed their quality of care and staffing according to payroll-based data.

They found that 16% of the nursing homes were in "severely disadvantaged" neighborhoods, and that these facilities were usually either for-profit, located in rural areas, or caring for a high proportion of Black residents and Medicaid recipients.

Also noted were significant staffing differences by neighborhood for nursing home workers providing direct care to residents. In the disadvantaged areas, staffing for physical and occupational therapists was 38% lower, 30% lower for RNs, and 5% lower for certified nursing assistants (CNAs).

"We found that nursing staff with generally lower salaries and training–CNAs and LPNs–had smaller or no disparities in staffing compared with RNs," Travers said. "This suggests that nursing homes in more disadvantaged communities may be substituting care by staff with less training."

The team concluded that certain interventions will be needed to improve the staffing disparity for nursing homes in disadvantaged areas; but in ways that will support the facilities, not penalize them.

"This might include enhancing Medicare and Medicaid reimbursement to the facilities using geographically 'micro-targeted' funding sources, workforce recruitment efforts focused on pay, transportation, and working conditions, and efforts to retain staff such as opportunities for CNAs and LPNs to complete training as RNs," Jason Falvey, PT, DPT, PhD, first author of the study, said in a statement.

“Most skilled nursing facilities are already concerned about low staff-to-resident ratios, but our analysis reveals that this gap is even worse in disadvantaged communities.”

Jasmyne Ray is the revenue cycle editor at HealthLeaders. 


Concern around nursing home staffing grew in the early days of the COVID pandemic.

Researchers used the deprivation index to measure the socioeconomic disadvantage of different neighborhoods and 12,609 nursing homes.

16% of the nursing homes surveyed were in disadvantaged neighborhoods, for-profit, located in a rural area, and with a high proportion of black and Medicaid residents.

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