COVID-19 Era Staffing Strains, Short-Term Compensatory Actions Shown to Negatively Impact Nursing Homes


This new research suggests a potential need for policymakers to examine nursing home regulations related to staffing and to collaborate with administrators to create better policies.

Nursing home administrators have faced major staffing strain due to COVID-19, according to recent findings, leading to implementation of potentially harmful short-term compensatory actions for maintenance of their operations.1

This new data resulted from an analysis which examined the effects of pandemic-era changes to nursing homes’ administrators, given the apparent strain that COVID-19 regulations had on may of these facilities.2

The study’s investigators sought to address the mixed data resulting from prior quantitative studies on staffing shortfalls, and the research was authored by Joan F. Brazier, MS, from Brown University’s School of Public Health in Providence, Rhode Island.

“This study conducted a qualitative assessment of nursing home administrator experiences during the pandemic and integrated qualitative findings with quantitative analysis of national payroll staffing data,” Brazier and colleagues wrote. “The objective was to provide context to conflicting aggregated data on nursing home staffing levels during the COVID-19 pandemic.”

Background and Findings

The investigators’ primary goal was to provide a thematic description of nursing facilities’ administrator compensatory strategies, with the overall aim of offering context for quantitative analyses on staffing levels of these homes at the time of the COVID-19 pandemic.

The research team used a qualitative study design in their analysis and utilized convergent mixed-methods analysis, integrating both quantitative and qualitative data sets. The team’s semi-structured qualitative interviews were performed from July of 2020, to December of 2021.

National Payroll Based Journal information from January of 2020, to September of 2022, were gathered by the investigators for 40 total US nursing homes in 8 health care markets. These represented diverse regions and nursing home utilization patterns.

Additionally, the research team derived staffing and resident measures from the Payroll Based Journal data and then compared the information with national trends for 15,436 total nursing homes in the US. The team recruited nursing home administrators to become involved in the interviews, and ultimately, 40 administrators consented, with 4 of them lost to follow-up.

Participants underwent 4 repeated semi-structured qualitative interviews conducted by the investigators, wherein the focus was on changes that had been observed during the COVID-19 pandemic in nursing facilities.

The investigators ended up with a total of 156 interviews of 40 administrators to investigate the effects of the pandemic on staffing, and they demonstrated that the administrators reported facing staff shortages at this time and used various compensatory strategies to cope with the difficult situation.

Some of these strategies which had been used included implementing overtime, adjusting staff-to-resident ratios, cross-training, using agency staff members, and employing limitations on new admissions to help maintain operations and meet the necessary minimum staffing regulations.

The research team also assessed Payroll Based Journal data, and their analysis confirmed the administrators' reports, suggesting that the facilities experienced a rise in the use of agency staff, reductions in staff hours, and a diminished resident census at the time of the pandemic. The team’s findings were consistent with the national trends that had been observed during the same time.

“More mixed-methods research is needed to better understand the long-term outcomes of the COVID-19 pandemic associated with nursing home staffing…” they wrote. “Policymakers should consider reviewing current nursing home regulations around staffing and work with nursing home administrators to create policies that more nimbly adjust to crisis management.”


  1. Brazier JF, Geng F, Meehan A, et al. Examination of Staffing Shortages at US Nursing Homes During the COVID-19 Pandemic. JAMA Netw Open. 2023;6(7):e2325993. doi:10.1001/jamanetworkopen.2023.25993.
  2. Giri S, Chenn LM, Romero-Ortuno R. Nursing homes during the COVID-19 pandemic: a scoping review of challenges and responses. Eur Geriatr Med. 2021;12(6):1127-1136. doi:10.1007/s41999-021-00531-2.
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