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Nursing Home Dementia Care Not Necessarily Elevated by Just Boosting Staff 

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by Zahida Siddiqi

Increasing nursing home staffing alone will not necessarily improve care quality for nursing home residents who have dementia.

This is the finding of a recently published study in the journal, Health Services Research, which combines the efforts of experts at UC-Irvine, UCLA, and the University of Chicago.

Researchers recommend looking beyond just staffing to improve dementia care.

“[I]ncreasing staffing hours alone is likely not enough to dramatically reduce adverse outcomes,” the researchers wrote.

Lead author Dana Mukamel, professor of medicine at UC-Irvine, told Futurity: “We found that registered nurses’ and certified nurse assistants’ staffing hours per resident-day were likely to improve outcomes for both high- and low-census dementia facilities, but that simply increasing staff is not likely to be a solution.”

Researchers instead emphasized the role of reducing turnover and providing specialized training to workers along with easy-to-navigate environments to be of greater significance to the quality of care involving dementia patients.

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“Providing appropriate, high-quality care to residents with [Alzheimer’s disease, related dementias or cognitive impairment] is not only a matter of employing more staff but also employing staff that is trained with techniques that have been shown to be efficacious,” the researchers said. “Staff consistency and predictability are also important, as these allow staff to become familiar with the residents, better understand them and create rapport.”

The study also noted that the impact on care differed by percentage of residents with dementia at each facility, and various outcomes such as performance of daily activities, including independently bathing, dressing, and eating as well as the number of emergency room visits and incidents of pressure sores.

More than 40% of nursing home residents have been estimated to have Alzheimer’s disease, related dementias or cognitive impairment, with a vast majority residing in general nursing homes, some in facilities in which they account for a relatively small fraction of the residents and others in facilities in which they account for a large majority.

“We wanted to understand the association of staffing hours with care quality and compare the health outcomes in nursing homes with high- and low-dementia populations,” Mukamel said.

And to that end, researchers noted that at any given level of staffing, absolute differences in outcomes between low- and high-dementia facilities existed. This suggests that much more than bolstered staffing will be required to close these gaps in care.

The study relied on Payroll-Based Journal (PBJ) from all 15,790 nursing homes nationally from January 2017 through September 2019. For the final sample, the data were merged to the Minimum Data Set (MDS), Nursing Home Care Compare (NHCC), and the Long-Term Care (LTC) Focus dataset.

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