A group of researchers from UCLA and Yale University conducted a study to look at the spread of COVID-19 by certified nursing assistants (CNAs) who work in multiple facilities—sometimes two or three at a time. CNAs are the frontline caregivers and provide the intimate and physical care of mostly elderly residents involving bathing, feeding, and dressing.
One CNA from the study described her work: “We do everything for them—everything you do for yourself, you have to do for the residents.” That CNA works 64 hours a week at two California nursing homes. She works at multiple nursing homes not because she wants to, but because the low pay and limited hours at each of the jobs makes it necessary in order for her to be able to pay her $2,200 monthly rent.
The study used location data from smartphones to observe the movements of nursing home workers going in and out of nursing homes after the visitor ban was in place. Each was working at more than one facility. The UCLA team created maps of movement and found that on average, each nursing home is connected to seven others through staff movement.
It was also noted that there are areas of the country with higher overlaps in nursing home staffing. The more shared workers a nursing home has, the greater the potential for having more COVID-19 infections among the residents.
Another contributing factor is the shortage of personal protective equipment (PPE) available from one facility to another. In one facility a CNA may be provided with an N95 mask, and in another a simple surgical mask.
An attorney with the California Advocates for Nursing Home Reform expressed that providing more funding doesn’t usually solve the problem because it doesn’t trickle down to the frontline workers needing the money. Instead he says, regulators need to focus on the basics of hand hygiene, especially in the 100 California nursing homes with ongoing outbreaks, since it’s been shown that infection control measures do work.
Compliance Perspective
Issue
The need for CNAs to work enough hours at the wage level they are paid in order to support themselves and their dependents may cause them to seek employment at multiple facilities. Consequently, this may contribute to the spread of the COVID-19 virus between the facilities, particularly when the person is working in different capacities at the facilities and being provided different types of PPE.
Discussion Points
- Review policies and procedures regarding CNAs who work at multiple facilities and how to alleviate risks of spreading COVID-19 between facilities.
- Train staff regarding the need to use appropriate PPE at all times, and to stringently follow hand hygiene and infection control protocols.
- Periodically audit to ensure that CNAs have access to adequate PPE and are carefully following hand hygiene and infection control protocols.
FOR MORE INFORMATION ON THIS TOPIC view: HAND HYGIENE GUIDELINES FOR HEALTHCARE SETTINGS.
