Improving Nursing Home Dementia Care Requires More Than Just Additional Staffing: Study

Increasing staffing levels in nursing homes has long been highlighted as the most critical step to improving the quality of dementia care provided; but the findings of a new study warns that may not be enough to ensure the best possible patient conditions.

Instead of just increasing staffing hours, researchers highlight the need for other targeted changes and interventions that will help improve quality and consistency of dementia care for a population of patients with specific care needs.

These changes include the need for staff stability, specialized training and improved facility design, according to findings published on December 29 in the journal Health Services Research.

Nursing Home Dementia Care Needs

Insufficient nursing home staffing has been widely identified as a common source of patient harm. According to a study published last year, only about 5% of nursing homes meet CMS proposed staffing levels. To add to the problem, most nursing homes lost half their staff during the pandemic and many haven’t replaced staffing to pre-pandemic levels.

Researchers from the University of California, Irvine studied the relationship between nurse staffing and health outcomes in nursing homes with low- and high-dementia cases. The study used a national sample of nursing homes from 2017-2019, with data from the Centers for Medicare and Medicaid Services (CMS) Payroll-Based Journal, Medicare Claims, Nursing Home Care Compare, and Long-Term Care Focus.

Researchers compared hours per resident-day and patient outcomes, determining that increasing staffing was not enough to improve care for Alzheimer’s patients.

Instead, the findings warn nursing home facilities not only need to increase staffing levels but also improve staff stability, provide specialized training to care for Alzheimer’s patients, and create easier to navigate facilities to prevent injuries and other problems.

The researchers found that increasing staffing levels often improves patient outcomes, but for facilities caring for dementia patients that may not be enough; especially considering many facilities often turn to “chemical restraint” by overly treating dementia patients with sedatives and other antipsychotic drugs.

The new data indicated that in high- and low-dementia facilities, outcome rates differed at all staffing levels.

For example, average predicted antipsychotic use and daily activities were worse in higher dementia facilities, but independent movement and hospitalizations did not differ significantly. Emergency room visits and pressure sores were worse in lower dementia facilities.

Patients with Alzheimer’s disease and dementia often have difficulty communicating symptoms and needs. Alzheimer’s care staff must be specially trained in how to care for their needs, techniques to recognize nonverbal cues, and have experience understanding how patients express themselves, including how they experience pain or ask for things.

The data indicates the impact on care relied more on how many patients with Alzheimer’s or dementia needed help with activities like bathing, dressing, and eating or if they experienced health issues, the number of emergency room visits, or incidents involving pressure sores.

Higher Quality Care Needed, Not Just Staffing

More than 40% of nursing home residents in the U.S have Alzheimer’s disease, dementia or cognitive impairment, according to data from the Alzheimer’s Association.

Researchers noted that providing them with high quality care not only requires adequate staffing, but it also calls for specialized training and care, focused on honing in on Alzheimer’s patients and managing their complex needs, as well as investing in a secure environment.

Study authors said more research is needed to determine specific areas to target to create opportunities for improvement for Alzheimer’s patients.

“These findings suggest that increasing staffing will improve outcomes by similar increments in both low- and high-dementia facilities for all outcomes,” the researchers concluded. “However, at any given level of staffing, absolute differences in outcomes between low- and high-dementia facilities remain, suggesting that additional staffing alone will not suffice to close these gaps.”