{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T03:10:43Z","timestamp":1792293043556,"version":"4.4.0"},"reference-count":38,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi230750-4\"><jats:title>Importance<\/jats:title><jats:p>Staffing shortages in nursing homes (NHs) threaten the quality of resident care, and the COVID-19 pandemic magnified critical staffing shortages within NHs. During the pandemic, the US Congress enacted the Paycheck Protection Program (PPP), a forgivable loan program that required eligible recipients to appropriate 60% to 75% of the loan toward staffing to qualify for loan forgiveness.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230750-5\"><jats:title>Objective<\/jats:title><jats:p>To evaluate characteristics of PPP loan recipient NHs vs nonloan recipient NHs and whether there were changes in staffing hours at NHs that received a loan compared with those that did not.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230750-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This economic evaluation used national data on US nursing homes that were aggregated from the Small Business Administration, Nursing Home Compare, LTCFocus, the Centers for Medicare &amp;amp;amp; Medicaid Services Payroll Based Journal, the Minimum Data Set, the Area Deprivation Index, the Healthcare Cost Report Information System, and the US Department of Agriculture Rural-Urban Continuum Codes from January 1 to December 23, 2020.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230750-7\"><jats:title>Exposure<\/jats:title><jats:p>Paycheck Protection Program loan receipt status.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230750-8\"><jats:title>Main Outcome and Measures<\/jats:title><jats:p>Staffing variables included registered nurse, licensed practical nurse (LPN), and certified nursing assistant (CNA) total hours per week. Staffing hours were examined on a weekly basis before and after loan receipt during the study period. An event-study approach was used to estimate the staffing total weekly hours at NHs that received PPP loans compared with NHs that did not receive a PPP loan.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230750-9\"><jats:title>Results<\/jats:title><jats:p>Among 6008 US NHs, 1807 (30.1%) received a PPP loan and 4201 (69.9%) did not. The median loan amount was $664\u202f349 (IQR, $407\u202f000-$1\u202f058\u202f300). Loan recipients were less likely to be part of a chain (733 [40.6%] vs 2592 [61.7%]) and more likely to be for profit (1342 [74.3%] vs 2877 [68.5%]), be located in nonurban settings (159 [8.8%] vs 183 [4.4%]), have a greater proportion of Medicaid-funded residents (mean [SD], 60.92% [21.58%] vs 56.78% [25.57%]), and have lower staffing quality ratings (mean [SD], 2.88 [1.20] vs 3.03 [1.22]) and overall quality star ratings (mean [SD], 3.08 [1.44] vs 3.22 [1.44]) (<jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001 for all). Twelve weeks after PPP loan receipt, NHs that received a PPP loan experienced a mean difference of 26.19 more CNA hours per week (95% CI, 14.50-37.87 hours per week) and a mean difference of 6.67 more LPN hours per week (95% CI, 1.21-12.12 hours per week) compared with nursing homes that did not receive a PPP loan. No associations were found between PPP loan receipt and weekly RN staffing hours (12 weeks: mean difference, 1.99 hours per week; 95% CI, \u22122.38 to 6.36 hours per week).<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi230750-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this economic evaluation, a forgivable loan program that required funding to be appropriated toward staffing was associated with a significant increase in CNA and LPN staffing hours among NH PPP loan recipients. Because the PPP loans are temporary, federal and state entities may need to institute sufficient and sustainable support to mitigate NH staffing shortages.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.26122","type":"journal-article","created":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T15:32:36Z","timestamp":1690471956000},"page":"e2326122","source":"Crossref","is-referenced-by-count":1,"title":["Association of Receipt of Paycheck Protection Program Loans With Staffing Patterns Among US Nursing Homes"],"prefix":"10.1001","volume":"6","author":[{"given":"Jasmine L.","family":"Travers","sequence":"first","affiliation":[{"name":"Rory Meyers College of Nursing, New York University Grossman School of Medicine, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian E.","family":"McGarry","sequence":"additional","affiliation":[{"name":"Division of Geriatrics and Aging, Department of Medicine, University of Rochester Medical Center, Rochester, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Friedman","sequence":"additional","affiliation":[{"name":"Department of Population Health, New York University Grossman School of Medicine, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louisa W.","family":"Holaday","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York"},{"name":"Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph S.","family":"Ross","sequence":"additional","affiliation":[{"name":"Section of General Medicine and the National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut"},{"name":"Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut"},{"name":"Center for Outcomes Research and Evaluation, Yale\u2013New Haven Hospital, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leo","family":"Lopez","sequence":"additional","affiliation":[{"name":"Institute for Public Health, University Health, University Medicine Associates, San Antonio, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Chen","sequence":"additional","affiliation":[{"name":"Office of Ambulatory Care and Population Health, New York City Health + Hospitals, New York"},{"name":"Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University Grossman School of Medicine, New 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