July 2020 - News and Notes – UCSF Health Workforce Research Center on Long-Term Care

The COVID-19 pandemic and national spotlight on racial inequities have increased the urgency of our work at the UCSF HWRC. Members of our team are supporting state and federal policymakers in their COVID-19 response and are embarking on a new set of rapid studies to provide further guidance. In addition, our research continues to focus on the workforce that cares for people who need long-term care services and supports. This workforce of essential workers faced substantial challenges before the pandemic, and their economic and health vulnerability is even more apparent today. Our work aims to ensure that we have a workforce of adequate size and preparation, and our desire for greater racial, gender, sexual, and economic equity provides constant inspiration for our work. As the inadequacy of our collective efforts to eliminate racist policies and increase racial equity thus far has been even more apparent, we are committed to increase our work in this area.

UCSF HWRC COVID-19 Workforce Support and Research

Our faculty and staff were asked to support California’s workforce planning for anticipated surges in hospital care due to the COVID-19 pandemic. Through our relationship with Healthforce Center at UCSF, we produced a set of recommendations to surge the workforce, developed staffing ratios and a staffing calculator to determining hiring needs for newly-opened COVID-19 hospitals, developed job action sheets for alternate care sites, developed orientation and training materials for alternate care sites, and collaborated with other state leaders to guide changes in nursing education to ensure that students could gain appropriate clinical experiences and enter the workforce. Our resources are available on the Healthforce Center COVID-19 Health Workforce Surge Planning website.

With supplemental support from the National Center for Health Workforce Analysis, our team is conducting three rapid studies on the COVID-19 workforce response:

  • Profiles of Alternate Care Settings. Several states and cities established alternate care sites, in locations such as convention centers and dormitories, to provide sub-acute care for people with SARS-Cov2 infection. We are studying the roles of these sites, their staffing mix, their recruitment and deployment strategies, and their training approaches.
  • Community paramedic roles in the COVID-19 response: We are identifying and describing models that communities can use to engage their community paramedic workforce to support local pandemic response.
  • Multiple job-holding among long-term care workers: Some front-line workers in long-term care hold multiple jobs because they are unable to support themselves and their families with the low wages and part-time hours of many long-term care jobs. We will use publicly-available data to assess the extent to which long-term care workers hold multiple jobs and the factors associated with multiple job-holding.


Nursing Staffing and Coronavirus Infections in California Nursing Homes

In the US, nursing home residents and staff have been severely impacted by the COVID-19 pandemic. A study, Nursing Staffing and Coronavirus Infections in California Nursing Homes, by Charlene Harrington, Susan Chapman, and Elizabeth Halifax from the School of Nursing and other colleagues compared nursing homes in California with and without COVID positive residents. They found that nursing homes with less than the recommended RN staffing levels, those with lower Medicare quality ratings, and those with a history of previous health deficiencies had a higher probability of having COVID-19 residents.

Establishing minimum staffing standards at the federal and state levels is critical to address the ongoing crisis in nursing homes and prevent this in the future.

HWRC Directors Come Together to Co-author NEJM Article on Pandemic Workforce Policies and Strategies

All seven of the Health Workforce Research Center directors from across the U.S., including our director, Joanne Spetz collaborated with Peter Buerhaus, director of the Montana State University Center for Interdisciplinary Health Workforce Studies to write a perspective piece published in the New England Journal of Medicine on policies and strategies to ensure and sustain the workforce for COVID-19 care. Erin Fraher, lead author of the article, was also interviewed for a related podcast published by the journal.

Long-Term Services and Supports Workers Spend More Time on Both Paid Work and Household Responsibilities than Other Workers

HWRC faculty member Ulrike Muench and HWRC colleagues Joanne Spetz and Matthew Jura analyzed the American Time Use Survey to learn how workers in long-term care spend their time compared with workers in other health care workers. In an article published in June, they reported that those who worked in long-term care earned lower wages, were more likely to experience poverty, and spent more time working, commuting, and on unpaid activities such as childcare and housework. This is the second publication from our HWRC project on the time use of long-term care workers.

Scope of Practice Restrictions in Behavioral Health can Impact Access to Services During COVID Pandemic

The COVID-19 pandemic has pushed issues relating to scope of practice regulations and restrictions on Nurse Practitioner (NP) practice to the forefront. Many Governors issued Executive Orders allowing waivers to current scope of practice restrictions in order to maximize the workforce response to the COVID crisis. Numerous studies show autonomous NP practice to be safe and effective. A recent study by HWRC Co-Director Susan Chapman and colleagues describes the costs and burdens of physician supervision for Psychiatric advanced practice registered nurses. These restrictions may limit patient access to much needed mental health services during the COVID crisis.

Patients’ Medication Adherence is Better in States that Give Nurse Practitioners Full Practice Authority

In a study funded by the Laura and John Arnold Foundation through a grant from the Health Care Cost Institute and National Academy for State Health Policy, HWRC researchers Ulrike Muench, Janet Coffman, and Joanne Spetz examined state scope of practice regulations for nurse practitioners (NPs) and their association with patients’ medication adherence. Using a large insurance claims dataset, they report in the Journal of General Internal Medicine that scope-of-practice regulations that allow NPs to practice and prescribe without physician oversight are associated with improved medication adherence. The authors conclude that their results suggest that policies allowing NPs to maximally use their skills can be beneficial to patients.

Policy Recommendations for the Opioid Crisis Amidst the Pandemic Crisis

The COVID-19 pandemic began while the United States was in the midst of a nationwide opioid crisis, and preliminary data indicate that opioid overdoses are rising amidst shelter-in-place policies and disruptions to substance use treatment programs. In a blog published by Healthforce Center at UCSF, HWRC Director Joanne Spetz makes three specific recommendations to ensure that people can access treatment for opioid use disorder, which is needed now even more than before.

Violence in Hospitals is Endemic and Under-Reported

Susan Chapman and colleagues examined reports of violence in hospitals that led to physical injury or police involvement. Their results, published in the American Journal of Industrial Medicine, found that violence in hospitals has likely been under reported. They also found that staff in ERs and inpatient psychiatry units are at highest risk for workplace violence.

Inaugural Health Workforce Research Centers Annual Report

The inaugural Health Workforce Research Centers (HWRCs') Annual Report highlights the work from the Health Resources and Services Administration (HRSA) funded centers throughout the country. This report introduces each center, their work, the conference season, and more.

Recent Publications from UCSF HWRC-LTC Investigators

Chu, L, Spetz, J. Survey of Nurse Employers in California, Fall/Winter 2018-19. San Francisco, CA: Healthforce Center at UCSF. April 2020.