Nursing Homes: The Deadliest Workplaces in the USA

Nursing Homes: The Deadliest Workplaces in the USA

As COVID-19 has ravaged nursing homes, it has also made working in these facilities the most dangerous job in America.

Since the start of the pandemic, facilities have reported 760 COVID-19-related deaths among their staff (as of August 2, 2020).

If deaths continue at this pace over a full year, it will equate to more than 200 fatalities per 100,000 workers.

This would more than double the rate of previous years’ deadliest occupations, such as logging and commercial fishing.

Challenges in Nursing Home Facilities

Nursing homes offer logistical challenges as well as challenges of staff shortages and lack of PPE, placing both HCW and residents at risk.

The acute shortage of personal protective equipment (PPE) has been disproportionately challenging for nursing homes compared to hospitals.

In the United States, accounts report that 70% of nursing home providers are unable to find sufficient supplies for their staff.

Space is also an issue. With the lack of readily available space to cohort infected residents, containing the infection has been difficult.

Residents sometimes live in a facility for years, and moving them to units dedicated to the care of those infected is challenging because it entails moving all their belongings.

Nursing homes have attempted to cohort staff by color coding units as green, yellow, and red, with “green units” being free of COVID-19 residents. Due to staffing shortages, nurses “floated” from one unit to another. This is a major factor in the spread of COVID-19.*

Staff Stressors

Nursing home staff are particularly fearful.

The pandemic has worsened the critical problem of chronic understaffing in nursing homes due to absenteeism and infected staff who were quarantined.

Many of those who stay on the job are income insecure and live in multigenerational households with household members at high risk to severe COVID-19.

Although COVID-19 is described as an “occupational disease” for which HCWs need social and psychological support, studies have found that staff feel unsupported and fear returning to work.

HCW foremost fear is fear of developing COVID-19 and transmitting the virus to their families and clients when they do not know they are infected.

The are also afraid of reinfection.

Globally, the sentiment of HCW taking care of elderly in long term care facilities echoes other HCW.

“Don’t give us a medal, give us PPE [personal protective equipment].”



Washington Post, “Nursing Home Workers Now Have the Most Dangerous Jobs in America”

* Chen, M.K., Chevalier, J.A. and Long, E.F., 2020. Nursing Home Staff Networks and COVID-19 (No. w27608). National Bureau of Economic Research.

Hoedl, M., Eglseer, D. and Bauer, S., 2020. Associations between personal protective equipment and nursing staff stress during the COVID-19 pandemic. medRxiv.

McGilton, K.S., Escrig-Pinol, A., Gordon, A., Chu, C.H., Zúñiga, F., Sanchez, M.G., Boscart, V., Meyer, J., Corazzini, K.N., Jacinto, A.F. and Spilsbury, K., 2020. Uncovering the devaluation of nursing home staff during COVID-19: Are we fueling the next health care crisis?. Journal of the American Medical Directors Association, 21(7), pp.962-965.

Seshadri, S., Concannon, C., Woods, J.A., McCullough, K.M. and Dumyati, G.K., 2020. “It’s like fighting a war with rocks”: Nursing home healthcare workers’ experiences during the COVID-19 pandemic. Infection Control & Hospital Epidemiology, pp.1-2.

Van Houtven CH, DePasquale N, Coe NB. Essential long-term care workers commonly hold second jobs and double- or triple-duty caregiving roles. Journal of American Geriatric Society 2020 Apr 27 [Epub ahead of print].