PPP loans helped nursing homes boost staff during pandemic, study finds

Despite years of chronic understaffing at US nursing homes, researchers found that one federal program helped long-term care facilities improve staffing levels at the height of the Covid-19 pandemic—even as many healthcare systems struggled to retain workers.

Nursing homes that received loans from the Paycheck Protection Program (PPP), which Congress created in 2020 to offset pandemic-related business losses, added almost 46 staffing hours per week within three months compared to those that didn’t get PPP loans, according to a study published in JAMA Network Open on Thursday.

That boost equated to about “two additional shifts per week one month after receiving a loan and four additional shifts per week six months after receiving a loan,” Jasmine Travers, an assistant professor at NYU’s Rory Meyers College of Nursing and the study’s lead author, said in an emailed statement.

Certified nursing assistants (CNAs) experienced the greatest improvements in staffing at PPP recipient nursing homes, with 26 more hours each week, followed by licensed practical nurses with seven additional hours each week, the study found. However, staffing hours for registered nurses (RNs) didn’t change substantially.

Researchers also found that nursing homes with insufficient staffing levels, low quality scores, and more Medicaid patients were more likely to receive PPP loans.

The study, which examined staffing trends at nursing homes from January to December 2020, compared the hours licensed practical nurses (LPNs), RNs, and CNAs worked before and after facilities got PPP loans. About 30% of the 6,000+ facilities researchers studied—or roughly 1,800 nursing homes—received PPP loans, with an average award of about $664,000.

But Travers called the loans “only a temporary fix.” Researchers concluded that lawmakers may need to institute similar programs to further mitigate nursing home staffing shortages.

“We need federal and state policies that provide sustainable support and incentivize nursing homes to invest in their staff long term,” Travers said. “This might look like increased Medicaid reimbursements and requiring that a percentage of nursing home revenue directly goes to paying for frontline staff.”