ArticleJournal of the American Medical Directors Association2023
Longitudinal Associations of Staff Shortages and Staff Levels with Health Outcomes in Nursing Homes.
Article in Journal of the American Medical Directors Association, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 32 citations in OpenAlex.
- Changes in Federal and State Policies on Visitation Restrictions in Nursing Homes During the COVID-19 Pandemic.Journal of applied gerontology : the official journal of the Southern Gerontological Society · 2025Pooled it
- Registered Nurse Workload and Resident Outcomes in Nursing Homes: A Scoping Review of Workforce Sustainability and Nursing Management.Journal of nursing management · 2026Review
- Nursing home visitor policy and COVID-19 infection rates.American journal of infection control · 2025Article
- Variations in State Essential Caregiver Programs for Nursing Homes During the COVID-19 Pandemic.Journal of applied gerontology : the official journal of the Southern Gerontological Society · 2025Article
- Medicaid Payments and Racial and Ethnic Disparities in Alzheimer Disease Special Care Units.JAMA network open · 2025Article
- Lifting Federal Visitation Restriction and COVID-19 Infections in Nursing Homes.Journal of the American Medical Directors Association · 2025Article
- Association of Racial and Ethnic Composition with Staff Levels in Nursing Homes: 2013-2019.Journal of the American Medical Directors Association · 2025Article
- Deployment of professional expertise during a period of disruption: A phenomenological study of rehabilitation clinicians.Journal of evaluation in clinical practice · 2025Article
- Patient-Reported Experiences in Vascular Surgery: A Qualitative Analysis of Care Quality.Health services insights · 2025Article
- Staffing Patterns in Nursing Homes, Assisted Living Communities, and Memory Care Units: Variation Across Shifts.Journal of the American Medical Directors Association · 2024Observational
- Falls in focus: an analysis of the rate of falls in 25 Australian residential aged care facilities from 2019 to 2021, pre- and during COVID-19 lockdowns.BMC health services research · 2024Article
- Organizational characteristics of highly specialized units for people with dementia and severe challenging behavior.BMC geriatrics · 2024Article
- Nursing Homes Increasingly Rely On Staffing Agencies For Direct Care Nursing.Health affairs (Project Hope) · 2024Article
- Nurse staffing disparities in nursing homes: Effects of community distress level and COVID-19.Nursing outlookObservational
- Understanding Pandemic Increases in Long-Stay Psychotropic Prescribing for Dementia Symptoms: A Survey of Nursing Home Clinicians.Gerontology & geriatric medicineArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 3 institutions in 1 country.
Funding
Abstract
objectivesTo examine whether facility-reported staff shortages and total staff levels were independently associated with changes in nursing home (NH) outcomes in 2020.
designLongitudinal cohort study. SETTING AND
participantsA total of 8466 NHs with staffing and outcome data.
methodsThis study used NH COVID-19 Public File (2020), Nursing Home Compare (2019-2020), and Payroll-Based Journal data (2019-2020). Outcome measures included the percentage of long-stay residents in a facility with declines in activities in daily living (ADLs), decreases in mobility, weight loss, and pressure ulcers in 2020 Q2, 2020 Q3, and 2020 Q4. Independent variables were whether NHs reported any shortage of aides or licensed nurses and total staff hours per resident day (HPRD). Separate 2-level (NH, state) Hierarchical Generalized Linear Mixed models examined the association of facility-reported shortages and staff hours with key NH resident outcomes, controlling for NH characteristics and COVID-19 infections.
resultsThe weekly percentage of NHs reporting any staff shortage averaged 20%. Total staff HPRD increased slightly from 3.7 in 2019 to 3.8 in 2020. Health outcomes were stable during 2019 and 2020 Q1 but worsened substantially starting in 2020 Q2. For example, the percentage of residents with mobility loss increased from 16.2% in 2020 Q1 to 27.9% in 2020 Q4. Facility-reported staff shortages were associated with an increase in the proportion of residents with an ADL decline (0.54 percentage points), mobility loss (0.80 percentage points), weight loss (0.22 percentage points), and pressure ulcers (0.22 percentage points) (all P < .01). Total staff HPRD was not associated with changes in any outcomes (all P > .05). CONCLUSIONS AND IMPLICATIONS: NHs reported worsened health outcomes among long-stay residents in 2020, with worse outcomes found among facilities that reported staff shortages but not among those with lower total staff levels. Facility-reported shortages provide important quality information during the COVID-19 pandemic.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.