{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T04:02:50Z","timestamp":1789012970448,"version":"build-2803163510"},"reference-count":32,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T00:00:00Z","timestamp":1757635200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000102","name":"Health Resources and Services Administration","doi-asserted-by":"publisher","award":["U1QHP28745"],"award-info":[{"award-number":["U1QHP28745"]}],"id":[{"id":"10.13039\/100000102","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R03AG088893"],"award-info":[{"award-number":["R03AG088893"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001080","name":"Patrick and Catherine Weldon Donaghue Medical Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001080","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Clarifying whether rural and non\u2010rural nursing homes implement different disaster\u2010related staffing approaches is vital to developing targeted preparedness strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective cohort study of 361 nursing homes exposed to Hurricane Michael (2018), we used a comparative interrupted time series design to assess changes in staffing intensity and composition from 30\u2009days before landfall to 7\u2009days after. We examined three outcomes using the Centers for Medicare &amp; Medicaid Services (CMS) Payroll Based Journal: total staffing intensity (hours per resident per day), licensure composition (percentage of registered nurses (RN) and licensed practical nurses (LPN)), and employment composition (percentage of routine staff who are not independent contractors). We evaluated staffing intensity with linear mixed\u2010effects models and licensure and employment composition using linear probability models. We report point estimates and 95% confidence intervals (CI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 361 nursing homes, 39.9% were rural. At baseline, rural facilities had 8% (0.92; 95% CI 0.87\u20130.96) lower total staffing intensity compared to non\u2010rural facilities. In the post\u2010event period, rural facilities increased total staffing by an additional 4% (95% CI 1.02 to 1.06) in the post\u2010event period compared to non\u2010rural facilities. Rural facilities increased their routine staff representation (0.46% points; 95% CI 0.14 to 0.78) but decreased licensed staff representation (\u22121.00% points; 95% CI \u22121.39 to 0.61) compared to the post\u2010disaster staffing changes in non\u2010rural facilities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Distinct disaster\u2010related staffing approaches may heighten baseline staffing differences between rural and non\u2010rural nursing homes. Disaster\u2010related staffing intensity increased in rural facilities, with rural facilities starting from a lower baseline. Although rural facilities may have benefited from greater reliance on routine staff, they were unable to augment licensed nurse staffing. These findings offer foundational evidence regarding the influence of baseline staffing practices and local healthcare workforce conditions on disaster\u2010related staffing strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.70098","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T14:48:32Z","timestamp":1757688512000},"page":"3829-3835","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Comparing Disaster\u2010Related Surge Staffing Practices Across Rural and Non\u2010Rural Nursing Homes"],"prefix":"10.1111","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4487-6832","authenticated-orcid":false,"given":"Natalia","family":"Festa","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Yale School of Medicine  New Haven Connecticut USA"},{"name":"VA Connecticut Healthcare System  West Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelsey","family":"Alexovitz","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6654-0710","authenticated-orcid":false,"given":"Kendra","family":"Davis\u2010Plourde","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Yale School of Public Health  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Marottoli","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Yale School of Medicine  New Haven Connecticut USA"},{"name":"VA Connecticut Healthcare System  West Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9161-8436","authenticated-orcid":false,"given":"Andrew B.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Yale School of Medicine  New Haven Connecticut USA"},{"name":"VA Connecticut Healthcare System  West Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Dosa","sequence":"additional","affiliation":[{"name":"University of Massachusetts Chan Medical School  Worcester Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terry","family":"Fulmer","sequence":"additional","affiliation":[{"name":"The John A. Hartford Foundation  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6450-0368","authenticated-orcid":false,"given":"Thomas M.","family":"Gill","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,12]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/JGS.17220"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.JAMDA.2021.09.038"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/JAMAHEALTHFORUM.2021.3900"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/1533317512454709"},{"key":"e_1_2_11_6_1","unstructured":"Department of Health and Human Services. Centers for Medicare & Medicaid Services \u201cMedicare and Medicaid Programs; Minimum Staffing Standards for Long\u2010Term Care Facilities and Medicaid Institutional Payment Transparency Reporting. Federal Register \u201d2024 https:\/\/www.federalregister.gov\/documents\/2024\/05\/10\/2024\u201008273\/medicare\u2010and\u2010medicaid\u2010programs\u2010minimum\u2010staffing\u2010standards\u2010for\u2010long\u2010term\u2010care\u2010facilities\u2010and\u2010medicaid."},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1017\/DMP.2021.276"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/24694452.2016.1194740"},{"key":"e_1_2_11_9_1","unstructured":"D. R.Levinson \u201cOffice of Inspector General Nursing Home Emergency Preparedness and Response During Recent Hurricanes \u201d2006 http:\/\/oig.hhs.gov."},{"key":"e_1_2_11_10_1","unstructured":"D. R.Levinson \u201cOffice of Inspector General: Gaps Continue to Exist in Nursing Home Emergency and Preparedness and Response During Disasters: 2007\u20132010 \u201d2012 http:\/\/oig.hhs.gov."},{"key":"e_1_2_11_11_1","unstructured":"A.Maxwell \u201cNursing Homes Reported Wide\u2010Ranging Challenges Preparing for Public Health Emergencies and Natural Disasters \u201d2023."},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1017\/DMP.2020.211"},{"key":"e_1_2_11_13_1","unstructured":"A. A.Anzaldua R. 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W.Olsho \u201cNursing Home Staffing Study \u201d2023 https:\/\/edit.cms.gov\/files\/document\/nursing\u2010home\u2010staffing\u2010study\u2010final\u2010report\u2010appendix\u2010june\u20102023.pdf."},{"key":"e_1_2_11_28_1","unstructured":"S.Adams M.Dempsey L.Frazier et\u00a0al. \u201cUse of Contract Staff in Nursing Homes Remains High After the COVID\u201019 Pandemic \u201d2025 https:\/\/aspe.hhs.gov\/sites\/default\/files\/documents\/0efd4ee9d0d0e9e67c5442141053d71c\/contract\u2010staff\u2010nhs\u2010high\u2010after\u2010covid.pdf."},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.3928\/19404921\u201020100831\u201001"},{"key":"e_1_2_11_30_1","unstructured":"P.Hung M.Casey andI.Moscovice \u201cPolicy Brief: Nurse Staffing Levels and Quality of Care in Rural Nursing Homes \u201d2015 https:\/\/www.ruralhealthresearch.org\/publications\/953."},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1093\/GERONI\/IGAD104.0747"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.JAMDA.2008.05.007"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/J.1532\u20105415.2012.04146.X"}],"container-title":["Journal of the American Geriatrics Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgs.70098","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T04:18:18Z","timestamp":1767068298000},"score":1,"resource":{"primary":{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/10.1111\/jgs.70098"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,12]]},"references-count":32,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1111\/jgs.70098"],"URL":"https:\/\/doi.org\/10.1111\/jgs.70098","archive":["Portico"],"relation":{},"ISSN":["0002-8614","1532-5415"],"issn-type":[{"value":"0002-8614","type":"print"},{"value":"1532-5415","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,12]]},"assertion":[{"value":"2025-04-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}