Increasing Staffing at Long-Term Care Facilities May Reduce Hospitalizations for Pneumonia, Influenza

Reducing hospitalizations for pneumonia and influenza at long-term care facilities may come down to modifiable characteristics, including staffing and care practices, a recent study found.

The study, published in the journal Open Forum Infectious Diseases, noted that about 90% of deaths from pneumonia and influenza occur among people age 65 or older, with the risk being particularly high among people living in long-term care facilities.

The cohort study of 2013-2015 Medicare claims looked at nearly 1.8 million residents who stayed at long-term care facilities for less than 100 days and nearly 923,000 who stayed for 100 or more days and calculated risk-standardized incidence rates (RSIR) for pneumonia and influenza hospitalizations.

“Our study showed that long-term care facilities with higher staffing hours per resident, employing skilled providers such as nurse practitioners and physician assistants, and higher quality care practices had fewer pneumonia and influenza hospitalizations,” study author Elliott Bosco, PharmD, a PhD student in Health Services Research in the Department of Health Services, Policy and Practice at Brown University School of Public Health, told Contagion^®. “These results were consistent for both the short-stay and long-stay populations.”

The study sought to address limitations of previous research by examining a large set of national data, considering the time residents spent in long-term care facilities, and distinguishing between short-stay and long-stay populations.

Among the short-stay population, 52.6% of long-term care facilities had at least 1 hospitalization for pneumonia or influenza, compared with 87.6% among the long-stay population. Investigators calculated RSIRs for pneumonia and influenza by adjusting for demographic and clinical covariates.

RSIR per 100 person-years ranged from 5.14 to 39.79 for short-stay populations and 2.96 to 51.96 for long-stay populations. Lower RSIRs were associated with more licensed independent practitioners, higher registered nurse hours per resident per day, and fewer residents prescribed antipsychotics.

“We were surprised to find that almost all potentially modifiable characteristics, such as staffing hours and skilled providers, were associated with lower pneumonia and influenza hospitalization rates for both short-stay and long-stay population,” Bosco told Contagion^®. “The findings suggest that these factors may contribute meaningfully to prevention and management of pneumonia and influenza in long-term care facilities.”

Further research is needed to explore how hospitalizations vary throughout the United States, and investigators will map county-level hospitalization rates among short-state and long-stay populations.

“Pneumonia and influenza expose long-term care facility residents to risks, such as hospitalization, that may negatively affect their health and increase the cost of care,” Bosco said. “Infection risk can be modified through the use of preventive measures or appropriate management protocols. Allocating resources to support these efforts in appropriately staffed facilities with skilled providers may be a modifiable means of reducing pneumonia and influenza infection risk.”

Staffing consideration also affected antibiotic treatment in nursing homes, which is a concern with the increasing prevalence of antimicrobial-resistant infections, according to a recent study that found that high rates of staff turnover in nursing homes affect antibiotic stewardship programs.

The most recent flu season was the longest in a decade, although it was milder than the 2017-18 season, which led to nearly 80,000 deaths, the US Centers for Disease Control and Prevention (CDC) noted. This season, the CDC estimated that there were as many as 42.4 million flu illnesses, 630,000 hospitalizations, and 59,500 flu-related deaths this season through April 20.