Achieving higher staffing levels does not resolve key discrepancies between nursing homes with higher and lower percentages of residents with Alzheimer’s, dementia and other cognitive impairments, a new study published in Health Services Research reveals.
The researchers from the universities of California and Chicago suggest that nursing homes should look to other methods to ensure adequate care can be delivered to cognitively impaired residents.
The Dec. 29 study shows that increased staffing and hours per resident day are consistently linked to higher care quality, but in ways that differ markedly between high- and low-dementia facilities. No matter how much staffing was available, high-dementia facilities still struggled with some aspects of care, while low-dementia facilities struggled in others.
“While improving its performance, [a nursing home’s] range of improvement will be limited to improvement on its own trajectory,” the authors noted.
Specifically, high-dementia nursing homes were better at preventing pressure sores and hospitalizations following an ER visit. Low-dementia nursing homes, on the other hand, had better outcomes in maintaining residents’ activities of daily living and optimal use of antipsychotic medications.
Closing the gap
These divergent outcomes can likely be addressed but not by simply adding more staff and nursing hours per resident day, suggested lead author Dana B. Mukamel, PhD, professor of medicine, public health and nursing at the University of California.
“Our study finds that two things matter — number of staff and staff training, skills and knowledge,” Mukamel told McKnight’s Long-Term Care News. “Those nursing homes that have low staffing should definitely first attend to increasing staffing size…. Those facilities that are already well staffed, or are finding that increasing staffing at this time due to shortages is not feasible, should consider specialized training for staff caring for residents with dementia.”
Training and staff retention are especially important due to the complexities of caring for residents with dementia or other cognitive impairments. A mid-December report confirmed that staff education programs can reduce the use of psychotropic medications as sedatives, backing up the new study’s suggestions.
The authors suggested that further research needs to be done into the effects of staff stability and turnover on dementia care.
“Other studies that will be done in the future will examine more specific staffing protocols and linking them to other health outcomes for residents with dementia,” Mukamel said. “These would be helpful in improving the care for these residents and identifying specific quality improvement for them.”
