Increased staffing may only be part of improved care for nursing home residents with dementia

Higher nursing home staff levels may have a positive effect on health outcomes for residents with Alzheimer's disease or a related dementia, but substantially improving care quality may require additional measures. Findings from the NIA-funded study, published in Health Services Research, also underscore the importance of reducing staff turnover, specialized staff training, and better facility design.

Providing high-quality care for individuals with dementia residing in nursing homes requires staff who are trained to understand nonverbal cues, build rapport with residents, and create a safe environment. However, staff turnover and labor instability often hinder the consistency and predictability of care in nursing homes. Previous studies have compared health outcomes of nursing home residents with dementia in specialized care units to those in general care units, but findings were mixed. To add to this understanding, a research team led by scientists at the University of California, Irvine and the University of Chicago set out to examine how nursing home staffing levels relate to the health outcomes of residents, particularly in nursing homes with differing numbers of residents with dementia.

The researchers analyzed data on staffing and health outcomes from 15,790 nursing homes across the United States from 2017 to 2019. The researchers looked at selected health outcome measures important for residents with dementia, including antipsychotic medication usage, changes in activities of daily living, mobility, risk of pressure ulcers, hospitalizations, and emergency department visits. They also considered resident characteristics - including age, race, and gender - as well as number of staff and staffing hours per resident each day for registered nurses, licensed practical nurses, and certified nurse assistants in their analysis.

Using statistical modeling, the researchers analyzed the relationship between staffing and health outcomes in nursing homes with different percentages of residents with dementia. They found that increased staffing of both nurses and nurse assistants tended to have positive effects on outcomes in most cases, regardless of whether the nursing home had a high or low number of residents with dementia.

However, at any given level of staffing, there were notable differences in outcomes between nursing homes with high and low populations of residents with dementia. In nursing homes with larger numbers of dementia patients, there was greater use of antipsychotics and greater decline in activities of daily living among residents. However, these same homes had better outcomes in terms of fewer pressure sores and fewer emergency room visits, when compared to nursing homes with fewer dementia residents. Independent movement and hospitalization outcomes did not differ significantly between the two types of homes. These outcome discrepancies among nursing homes with varying percentages of residents with dementia indicate that simply increasing staffing levels may not be sufficient to address disparities in care.

Overall, the study findings suggest that while increasing staffing can improve outcomes for residents in both types of nursing homes, this measure alone may not eliminate differences in outcomes between homes with high and low populations of residents with dementia. To close these gaps in care, the authors emphasize the importance of identifying other potential areas of improvement, including staff training, facility design, and staffing stability. Overall, the study underscores the importance of staffing in nursing homes and the need for targeted interventions to improve outcomes for residents with dementia. Future research may explore other factors such as racial disparities and dementia severity to better understand how they affect nursing home care quality.

This research was supported in part by NIA grant R01AG066742.

These activities relate to NIH's AD+ADRD Research Implementation Milestone 13.K, "Expand research leading to understanding of effectiveness and impacts of non-residential and residential care of PWD [people with dementia]."

Reference: Mukamel DB, et al. Dementia, nurse staffing, and health outcomes in nursing homes. Health Services Research. 2023. Epub Dec. 29. doi: 10.1111/1475-6773.14270.