OBJECTIVES: To examine the relationship between registered nurse (RN) burnout, job dissatisfaction, and missed care in nursing homes. DESIGN: Cross‐sectional secondary analysis of linked data from the 2015 RN4CAST‐US nurse survey and LTCfocus. SETTING: A total of 540 Medicare‐ and Medicaid‐certified nursing homes in California, Florida, New Jersey, and Pennsylvania. PARTICIPANTS: A total of 687 direct care RNs. MEASUREMENTS: Emotional Exhaustion subscale of the Maslach Burnout Inventory, job dissatisfaction, and missed care. RESULTS: Across all RNs, 30% exhibited high levels of burnout, 31% were dissatisfied with their job, and 72% reported missing one or more necessary care tasks on their last shift due to lack of time or resources. One in five RNs reported frequently being unable to complete necessary patient care. Controlling for RN and nursing home characteristics, RNs with burnout were five times more likely to leave necessary care undone (odds ratio [OR] = 4.97; 95% confidence interval [CI] = 2.56‐9.66) than RNs without burnout. RNs who were dissatisfied were 2.6 times more likely to leave necessary care undone (OR = 2.56; 95% CI = 1.68‐3.91) than RNs who were satisfied. Tasks most often left undone were comforting/talking with patients, providing adequate patient surveillance, patient/family teaching, and care planning. CONCLUSION: Missed nursing care due to inadequate time or resources is common in nursing homes and is associated with RN burnout and job dissatisfaction. Improved work environments with sufficient staff hold promise for improving care and nurse retention. J Am Geriatr Soc 67:2065–2071, 2019

Background/Objectives: The coronavirus disease 2019 (COVID‐19) pandemic has taken a disproportionate toll on long‐term care facility residents and staff. Our objective was to review the empirical evidence on facility characteristics associated with COVID‐19 cases and deaths. Design: Systematic review. Setting: Long‐term care facilities (nursing homes and assisted living communities). Participants: Thirty‐six empirical studies of factors associated with COVID‐19 cases and deaths in long‐term care facilities published between January 1, 2020 and June 15, 2021. Measurements: Outcomes included the probability of at least one case or death (or other defined threshold); numbers of cases and deaths, measured variably. Results: Larger, more rigorous studies were fairly consistent in their assessment of risk factors for COVID‐19 outcomes in long‐term care facilities. Larger bed size and location in an area with high COVID‐19 prevalence were the strongest and most consistent predictors of facilities having more COVID‐19 cases and deaths. Outcomes varied by facility racial composition, differences that were partially explained by facility size and community COVID‐19 prevalence. More staff members were associated with a higher probability of any outbreak; however, in facilities with known cases, higher staffing was associated with fewer deaths. Other characteristics, such as Nursing Home Compare 5‐star ratings, ownership, and prior infection control citations, did not have consistent associations with COVID‐19 outcomes. Conclusion: Given the importance of community COVID‐19 prevalence and facility size, studies that failed to control for these factors were likely confounded. Better control of community COVID‐19 spread would have been critical for mitigating much of the morbidity and mortality long‐term care residents and staff experienced during the pandemic. Traditional quality measures such as Nursing Home Compare 5‐Star ratings and past deficiencies were not consistent indicators of pandemic preparedness, likely because COVID‐19 presented a novel problem requiring extensive adaptation by both long‐term care providers and policymakers.

OBJECTIVE: To identify county and facility factors associated with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) outbreaks in skilled nursing facilities (SNFs). DESIGN: Cross‐sectional study linking county SARS‐CoV‐2 prevalence data, administrative data, state reports of SNF outbreaks, and data from Genesis HealthCare, a large multistate provider of post‐acute and long‐term care. State data are reported as of April 21, 2020; Genesis data are reported as of May 4, 2020. SETTING AND PARTICIPANTS: The Genesis sample consisted of 341 SNFs in 25 states, including a subset of 64 SNFs that underwent universal testing of all residents. The non‐Genesis sample included all other SNFs (n = 3,016) in the 12 states where Genesis operates that released the names of SNFs with outbreaks. MEASUREMENTS: For Genesis and non‐Genesis SNFs: any outbreak (one or more residents testing positive for SARS‐CoV‐2). For Genesis SNFs only: number of confirmed cases, SNF case fatality rate, and prevalence after universal testing. RESULTS: One hundred eighteen (34.6%) Genesis SNFs and 640 (21.2%) non‐Genesis SNFs had outbreaks. A difference in county prevalence of 1,000 cases per 100,000 (1%) was associated with a 33.6 percentage point (95% confidence interval (CI) = 9.6–57.7 percentage point; P = .008) difference in the probability of an outbreak for Genesis and non‐Genesis SNFs combined, and a difference of 12.5 cases per facility (95% CI = 4.4–20.8 cases; P = .003) for Genesis SNFs. A 10‐bed difference in facility size was associated with a 0.9 percentage point (95% CI = 0.6–1.2 percentage point; P < .001) difference in the probability of outbreak. We found no consistent relationship between Nursing Home Compare Five‐Star ratings or past infection control deficiency citations and probability or severity of outbreak. CONCLUSIONS: Larger SNFs and SNFs in areas of high SARS‐CoV‐2 prevalence are at high risk for outbreaks and must have access to universal testing to detect cases, implement mitigation strategies, and prevent further potentially avoidable cases and related complications. J Am Geriatr Soc 68:2167–2173, 2020.

Since the deployment of the messenger RNA (mRNA) vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)^1,2 in nursing homes nationwide starting in mid-December 2020, aggregate public data have shown decreases in the incidence of cases of SARS-CoV-2 infection and related deaths.³ However, there have been minimal individual-level data available for understanding vaccine effectiveness in nursing home residents, who were absent from the clinical trials and who often have reduced immune responses.⁴ Using electronic health record data from Genesis HealthCare, a large long-term care provider in the United States, we report the incidence of SARS-CoV-2 infection among vaccinated residents and unvaccinated residents of 280 nursing homes across 21 states.