Young healthcare worker speaking with elderly person in wheelchair

Higher staffing levels in long-term care facilities are linked with lower rates of antipsychotic prescribing, finds a new study representing data from most U.S. nursing homes.

Investigators examined records across more than 10,400 facilities including staffing levels and the frequency of inappropriate antipsychotic prescribing between 2016 and 2018. Data came from the federal Nursing Home Compare and Brown University’s LTCFocus datasets.  

Facilities overall had a 15.24% rate of antipsychotic use, with a significant association between how well they were staffed and level of inappropriate prescribing, reported Dallas P. Seitz, MD, PhD, of Queen’s University and Calgary University in Canada. 

Licensed staff hours

Higher prescribing rates were most strongly associated with licensed staff hours, including that of registered nurses and licensed practical nurses. Specifically, the researchers found a 2.25% decrease in prescriptions per unit increase in RN staffing hours, and a 1.83% decrease in prescriptions per unit increase in LPN staffing hours. Nursing aide staffing hours were not tied to antipsychotic use, Seitz and colleagues noted.

“Nonpharmacological strategies are recommended as the first-line strategy to address behaviors in dementia; however, this approach is more time-consuming and therefore more difficult in low-staffing environments,” they wrote.

CMS data lines up

The results mirror those reported by the Centers for Medicare & Medicaid Services. Between 2011 and 2021, there has been an overall decrease of 39% in LTC use of the drugs to a low of 14%, CMS reported in April. But this varies by state and CMS region. In some areas, the reduction has been as high as 45%. The agency continues to promote further reductions as part of its National Partnership to Improve Dementia Care in Nursing Homes.

Meanwhile, the new study results and those of similar studies suggest a course for better meeting CMS’ antipsychotics reduction goals, Seitz and colleagues wrote.


Solutions could include changing the skill mix of staff, the researchers said.  Boosting the percentage of highly trained personnel may better meet the increasingly complex health needs of LTC residents, they noted. Another way to meet this need is to implement staff training and educational interventions, they added.

Policy changes are also needed to further reduce the use of antipsychotics in nursing facilities, they said.

“As staffing levels increase, the capacity of LTC staff to provide quality care to residents is presumed to increase, allowing staff the time and capacity to more effectively address behavioral and psychological symptoms of dementia using nonpharmacological strategies,” which is the recommended best practice, they wrote.

Full findings were published in JAMDA.

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