Nursing Home Staffing Solutions Could Reduce Hospitalizations by Thousands Each Year

Researchers have found that financially rewarding nursing homes which hire additional staffing will provide substantial health benefits for residents.

The findings of new research suggests that incentivizing nursing homes to implement staffing increases could help avoid more than 6,000 hospitalizations every year, while substantially improving the quality of care in facilities.

According to a study published in the journal JAMA Health Forum on January 16, increasing nursing home staffing by 12% could reduce hospitalization rates by up to 4% and lead to broader long-term health improvements.

The Centers for Medicare & Medicaid Services (CMS) considers staffing to have “the greatest impact on the quality of care nursing homes deliver.” However, nursing homes are suffering major staffing shortages nationwide in the wake of the COVID-19 pandemic.

More than 90% of nursing homes in the U.S. are understaffed, and data indicates staffing shortages are being exacerbated by mental health issues suffered by staff members, including depression and anxiety. Another factor worsening nursing home problems are the widespread immigration crackdowns. The stricter policies are reducing the number of workers entering the United States who are able to fill crucial caregiving roles in nursing homes.

The staffing issues come as major problems plague nursing homes throughout the U.S. Rampant infections including flu, COVID-19 and other outbreaks often move through facilities quickly, devastating nursing homes and causing widespread death.

For the new study, researchers from the University of California, Los Angeles (UCLA) studied how improving staffing in Illinois nursing homes affected patient outcomes.

Led by Dr. Andrew Olenski, the researchers analyzed linked Medicare claims and Minimum Data Set assessments from the second quarter of 2021 through the third quarter of 2023 to track deaths, hospitalizations and emergency room visits among nursing home residents in Illinois.

The study examined quarterly and annual health assessments for 2.55 million long-term residents, focusing on facilities with above-median Medicaid populations before the reforms. Outcomes before and after the policy changes were then compared with similar high-Medicaid facilities in other states and with lower-Medicaid facilities in Illinois.

The researchers reimbursed nursing homes that increased staffing $36.68 per Medicaid nursing home resident-day. The incentive helped increase nurse staffing by 12% compared to the baseline. Data indicates the increased staffing helped decrease 90-day hospitalization rates by 4%, which researchers estimate would reduce hospitalizations by up to 6,142 individuals each year.

The value-based system helped some aspects of patient health. However, those improvements would be even more meaningful at scale if implemented throughout the entire country, the researchers noted.

“In this case-control study, we found that a Medicaid policy that incentivized high staffing levels was associated with modest improvement in some dimensions of patient health. However, even modest effects are extremely meaningful at scale: these estimates suggest that if a similar reform were adopted nationally, there would be 6142 fewer hospitalizations each year.”

— Dr. Andrew Olenski, Health Impacts of Nursing Home Staffing

They concluded that the findings show linking payments to staffing did have measurable health benefits. Hospitalizations were reduced, which can translate to other positive outcomes like fewer infections and lower death rates. The team called for more studies to determine if the increases in staffing levels truly resulted in better health for patients and if there are other incentives that could also help improve those levels.

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