As nursing homes battle coronavirus, study finds key defense: full staffs

At a time when nursing homes continue to be among the hardest hit settings in the coronavirus pandemic, new studies are beginning to offer insight as to why some facilities are seeing more cases than others -- and, according to one, how important nursing home employees themselves are to the fight.

A study released on Monday by The Journal of the American Medical Association (JAMA), found that across eight states those facilities that were able to maintain more staffing in the homes had fewer COVID-19 cases than staffing in homes the study rated as low-performing.

The study, by Harvard researchers, looked into outbreaks of coronavirus in California, Connecticut, Florida, Illinois, Maryland, Massachusetts, New Jersey, and Pennsylvania. Researchers used federal reviews based on health inspections, quality measures and nurse staffing to see if facilities with poor performance ratings in those categories had more viral infections or deaths.

When it came to health inspection or quality measure ratings, the study found no significant difference in the burden of COVID-19 cases between the homes. But the data did suggest one interesting data point: Facilities with nurse staffing shortages may be more susceptible to the spread of the virus.

The report published by JAMA acknowledged the importance of infection control practices but pointed out that policies that provide immediate staffing support "may be more effective at mitigating the spread of COVID-19."

The study used "mean staffing hours per resident by qualified nursing staff" as the metric for nurse staffing ratings.

Eric Carlson, a long-term care expert with the advocacy group Justice in Aging, told ABC News that when facilities don't have enough staff, residents suffer from lower quality of care.

"When nurse aides are responsible for too many residents, they don't have the time to follow the proper infection prevention procedures," said Carlson. "It's penny wise and pound foolish for facilities to short-staff facilities, since this research shows that overworked staff leads to infections and deaths. "

Toby Edelman, a senior policy attorney for the Center for Medicare Advocacy, a nonprofit, organization that provides education, advocacy and legal assistance to help older people and people with disabilities obtain health care, told ABC News that nursing homes have struggled to meet federal standards on staffing levels even before the coronavirus pandemic.

"Nursing facilities with more registered nurses and higher nurse staffing levels in general are more effective in containing the coronavirus than facilities with fewer nurses," Edelman said.

Meanwhile, a study released by the Centers for Disease Control and Prevention on Tuesday, centered on the need for long term care facilities to more closely monitor residents who regularly leave the facility for outpatient health care.

The study, which followed an outbreak in a Maryland nursing home, found that patients who need dialysis, a treatment for kidney failure, were more likely to have COVID-19, possibly because of their frequent exposures outside the nursing home to both community dialysis patients and staff members at dialysis centers.

According to the report of the study, the hospitalization rate for residents who received dialysis was higher than among residents not receiving dialysis.

The CDC report emphasized that nursing home residents who undergo dialysis are a particularly vulnerable population because they often have more underlying medical conditions like diabetes-mellitus, hypertension and heart disease.

"The issue in Maryland is another wake up call about the challenges of the spread of COVID-19 in nursing homes," said Dr. Jay Bhatt, an internist in Chicago and an ABC News contributor. "The report underscores the grave risk COVID-19 poses to people that have chronic disease, are immunocompromised or on dialysis. COVID-19 has made it no secret that nursing homes are at high risk of spread, infection, and poor outcome."

The report advised that clear communication between nursing homes and dialysis centers, and coordination of testing practices between the sites are key to preventing COVID-19 outbreaks.

"It is critical that long term care facilities and nursing homes have protocols in place to ensure that preventive measures we know work are in place to keep patients and their families safe," Bhatt said.

What to know about coronavirus:

• How it started and how to protect yourself: Coronavirus explained
• What to do if you have symptoms: Coronavirus symptoms
• Tracking the spread in the U.S. and worldwide: Coronavirus map