An analysis of the forgivable loans that many nursing homes took during the pandemic shows that additional funding can positively deliver higher staffing levels. The research gives a potential boost to advocates pushing states to increase Medicaid funding in the face of staffing mandates.
The new study found that nursing homes that received a Paycheck Protection Program loan had 34.84 more total staffing hours per week than facilities that did not receive a loan. Results appeared in JAMA Network Open on Thursday.
There were 6,008 nursing homes in the country eligible for the program, but just 1,807 – or slightly more than 30% of those eligible – received the funds. Researchers used data from one non-public and seven public sources, including Payroll Based Journal data and the Small Business Administration.
“Our research on PPP funds gave us a deeper understanding on minimum nursing staff expenditure regulations and how they are associated with staffing outcomes, such as staffing hours,” Jasmine Travers, PhD, assistant professor at NYU Rory Meyers College of Nursing, and the lead study author, told McKnight’s Long-Term Care News on Thursday.
While the study’s authors acknowledge certain limitations in their research — namely that the loans were temporary, and the data did not show variations in staffing hours based on nursing specialties — it does reveal some correlation between an increase in dedicated funding and staffing levels.
“Our study shows that funding in the presence of a minimum nursing staff expenditure regulation can support increased staffing levels within weeks,” Travers said.
The research found some common characteristics among facilities that received PPP loans: They were more likely to have lower staffing levels and lower quality ratings when applying for the loans; have higher percentages of Medicaid beneficiaries as residents; were less likely to be part of a chain; were more likely to be for-profit; and were more likely to be located in nonurban areas.
The median loan amount for nursing homes was $664,349. The federal government forgave PPP loans so long as employers dedicated at least 60% to 75% on payroll.
Twelve weeks after receiving the PPP loans, facilities produced an average of 34.84 more total staffing hours per week, compared to nursing homes that did not get a loan, study data showed.
Some of the starkest differences were apparent in the lower nursing roles: Researchers found that both certified nurse aide and licensed practicing nurse hours rose to 26.19 hours per week for PPP loan recipients versus 6.67 hours per week for non-recipients.
Based on the median CNA cost of $30,290 annually and $14.56 per hour, recipient facilities would have been able to pay for 43,956 additional CNA hours (or 17,153 additional RN hours) with the loans, study authors said.
Put in other terms, it equated to two more shifts per week within a month after receiving a PPP load and four added shifts weekly within six months, Travers said.
“We need federal and state policies that provide sustainable support and incentivize nursing homes to invest in their staff long-term,” she said.
The LTC sector is still waiting for the Centers for Medicare & Medicaid Service to announce its anticipated staffing rule, which some observers have speculated could require 4.1 hours of care per week per resident. A number of states have instituted their own staffing mandates although sector advocates and providers have said that such rules need to be accompanied by an increase in Medicaid dollars so as not to create unfunded mandates.
The study is titled “Association of Receipt of Paycheck Protection Program Loans With Staffing Patterns Among US Nursing Homes” and was undertaken by a handful of prominent researchers.
