Nurse Staffing Shortages Reducing Older Americans Access to Care: Study

Researchers warn the detrimental effects may extend beyond nursing homes and long-term care facilities, also affecting nearby hospitals.

New data indicates the number of beds in skilled nursing facilities across the U.S. dropped by 2.5% in the wake of the COVID-19 pandemic.

According to findings published in the journal JAMA Internal Medicine on January 12, the U.S. experienced a drop in skilled nursing facility beds and a decrease in overall operating capacity after the pandemic subsided, especially in rural counties. Researchers say the changes greatly impair access to care for older patients.

The three-year-long COVID-19 pandemic magnified existing deficiencies in the healthcare system, including staffing problems. Many hospitals experienced bed and staffing shortages that only worsened with the progression of the pandemic. Low nursing home staffing levels are believed to have contributed to a high number of COVID-19 deaths.

The issue of low staffing has continued after the pandemic was declared over. Currently, less than one-third of U.S. nursing homes have enough certified nursing assistants to meet the care needs of nursing home residents.

Previous research warns that healthcare staffing issues and hospital bed shortages will continue to plague the healthcare industry in the United States over the next decade. Spurred by an aging baby boomer population, severe shortages are projected by 2035, leading to a potential healthcare crisis and strained national resources.

For the study, researchers from Harvard University and the University of Rochester analyzed 2018 to 2024 data from the Centers for Medicare and Medicaid Services Payroll Based Journal, examining patient census trends at licensed skilled nursing facilities across the U.S. Led by Dr. Brian E. McGarry, the analysis found that the number of available beds has declined nationwide since 2019.

Skilled nursing facilities provide care for individuals with serious illnesses or injuries needing intensive care and rehab following a hospital stay or surgery. The facilities offer more care than home health or nursing homes. They are often an intermediate step between the hospital and other facilities for those who need more focused care and recovery.

According to the findings, from 2019 to 2024, the number of skilled nursing beds dropped by 2.5% across the U.S. At the same time, operating capacity dropped by 5%. Overall, 25% of counties across the U.S. experienced declines of skilled nursing capacity by 15% or more, especially in rural counties.

The areas that had the greatest drops also experienced staffing shortages and patients had longer hospital stays, often greater than 28 days. For every 1% drop in capacity, the facilities experienced more frequent reports of shortages and other consequences.

Researchers also found that hospitals near facilities with larger capacity declines saw longer average hospital stays, a greater share of stays lasting 28 days or more, and patients traveling farther on average to reach a skilled nursing facility.

They also pointed out that the decreasing capacity and drop in beds at these facilities may lead to impaired care or neglect and reduced access to care overall.

The team said these kinds of shortages may impact hospital quality of care in the long-term, warning that more people will need to stay in the hospital since there are fewer beds available in these facilities. That could lead to increased costs and impact resources available for other hospital patients.

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