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High-quality dementia care in homes ‘not just a matter of adding staff’  

Additional staffing alone is not sufficient to improve quality-of-care and health outcomes for patients with dementia living in nursing homes, according to US researchers.

They found that specialised training, an easy-to-navigate care environment and a stable workforce were also critical to meeting the unique challenges presented by the condition.

“Our findings highlight the fact that high-quality care involves not only increased staffing, but also specialised training”

Dana Mukamel

The findings, published in the journal Health Services Research, indicate that increased staffing levels generally improves outcomes for all patients.

However, at any given level of staffing, discrepancies between high- and low-dementia population facilities remained, said the researchers, in what they said was a first-of-its-kind study.

The impact on care differed by percentage of residents with dementia and various outcomes, ranging from independently bathing, dressing and eating to the number of hospital visits and pressure ulcers.

Those behind the study highlighted that more than 40% of nursing home residents nationally in the US were estimated to have Alzheimer’s disease, related dementia or cognitive impairment.

Researchers conducted regression analyses on a national sample of nursing homes between 2017 and 2019, drawing on a variety of datasets and including a total of 13,256 facilities.

Independent variables included staff hours per resident-day and dementia population percentage, controlling for other resident and facility characteristics.

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Study first author Professor Dana Mukamel, from the University of California in Irvine, said: “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.

“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,” she said.

“Our findings highlight the fact that high-quality care involves not only increased staffing, but also specialised training in practices proven to be effective in managing the complexities of this condition, as well as providing a secure environment and maintaining staff consistency,”

Professor Mukamel added: “Further research is required to identify specific areas that can be targeted to pinpoint opportunities for improvement in both low- and high-dementia facilities.”

The research was supported with funding from the US National Institutes of Health’s National Institute on Aging.

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