Autumn in New York: The case of long-term care facilities in the "Safe Staffing" lawsuit with less staffing but similar COVID-19 outcomes.

BACKGROUND AND OBJECTIVES: In 2022, 239 New York state Long-Term Care Facilities (LTCFs) challenged a "Safe Staffing" law in court. Our study compares LTCFs involved and not involved in the lawsuit, testing for differences in staffing measures and resident outcomes during the first year of the COVID-19 pandemic.

RESEARCH DESIGN AND METHODS: New York LTCF level data were obtained from the Centers for Medicare and Medicaid Services 2019 organization and 2020 COVID-19 datafiles. These data were then linked to data from the Long-Term Care Community Coalition, which identified the LTCFs involved in the "Safe Staffing" lawsuit. We first tested for differences in reported 2019 staffing levels by lawsuit involvement. Second, we specified "Doubly Robust" regression models to test if lawsuit involvement was associated with differences in resident COVID-19 infections, COVID-19 deaths, and overall mortality.

RESULTS: LTCFs involved in the lawsuit reported lower staff ratings and fewer staffing hours compared to LTCFs not involved in the lawsuit. Despite finding higher rates of admissions with COVID-19 in LTCFs involved in the lawsuit, we did not find that COVID-19 infections, COVID-19 deaths, or overall mortality differed by lawsuit involvement.

DISCUSSION AND IMPLICATIONS: LTCFs involved in the lawsuit were deemed by policymakers as reducing staff, earning excess profits, and placing residents at-risk. While these LTCFs reported lower staffing levels, we observed no differences in resident outcomes during the first year of the COVID-19 pandemic. Researchers and policy makers should develop more nuanced perspectives concerning the relationship among LTCF staffing, outcomes, and organizational profitability.