Sending COVID-positive nursing home staff home means worse outcomes for patients, study says

Sending home nursing staff who are mildly ill with COVID-19 could lead to unnecessary hospital admissions, patient deaths and costs, according to a study. study published in JAMA network opened.

When nursing home staff who test positive for COVID-19 are sent home, it could exacerbate an already existing problem of understaffing, resulting in even more missed care assignments, hospitalizations and in-hospital deaths, according to the study authors.

The computer simulation modeling study was conducted by researchers from the Public Health Informatics, Computational, and Operations Research (PHICOR) at CUNY SPH, the Center for Transformative Geriatric Research at Johns Hopkins University School of Medicine, the California Association of Long Term Care Medicine, and the Division of Infectious Diseases at the University of California, Irvine.

Many nursing homes are currently understaffed. A previous study found that 94% of U.S. nursing homes were understaffed in 2021 and 72% of nursing homes had fewer staff in 2024 than before the pandemic. Some reasons for this understaffing include low employee wages, difficult working conditions, employee turnover and burnout, and the lack of minimum staffing standards.

This new modeling study estimated that, in the absence of COVID-19, 22% of resident care tasks were not completed given current staffing levels, with an average of 93.7 of 424 daily resident care tasks not completed (34,185 missed care tasks per years).

Annually, these missed tasks caused an average of 38 resident hospitalizations and 4.6 deaths per 100-bed nursing home, costing the Centers for Medicare and Medicaid Services (CMS) an average of $1.07 million.

Throughout the COVID-19 pandemic, national guidance has been to send staff who tested positive for COVID-19 home for up to ten days (or until the test was negative) to reduce the spread of the virus. This study found that sending staff home exacerbated understaffing, with 649.5 missed tasks annually (1.8 more per day), even when some tasks were performed by other staff in the nursing home.

These additional missed tasks caused an average of 4.3 additional hospital admissions and 0.66 deaths due to staff being sent home. Together, COVID-19 and these missed duties-related hospitalizations and deaths cost an additional $247,090. However, costs due to negative health outcomes from missed care tasks were 4.1 to 9.3 times greater than costs due to COVID-19.

A possible temporary alternative to sending people home is to instead allow only people with mildly ill symptoms to work while wearing an N95 mask.

For example, the study found that when 75% of mildly ill staff worked while wearing N95 respirators, there were an average of 240 fewer missed work days per year, 475.9 additional tasks completed, and 3.5 fewer hospital admissions related to missed tasks and 0.4 fewer deaths. compared to when all staff were sent home.

However, there were five additional COVID-19 cases in residents, but no additional COVID-related hospitalizations. Overall, allowing mildly ill staff to work while wearing N95 respirators saved an average of $85,470 annually. These costs associated with missed tasks were consistently greater than the costs of COVID-19 when mildly ill staff worked while wearing N95 respirators.

“While our research shows that allowing mildly ill staff to work while wearing an N95 respirator reduces understaffing due to COVID-19 leave and reduces unnecessary harm, employees should not be encouraged to work while they are sick and contagious,” said senior author Bruce Y. Lee, professor at CUNY SPH and executive director at PHICOR.

“We need to find ways to solve the underlying problem of underemployment, such as offering competitive wages.”