Specialized dementia care in nursing homes linked to better outcomes for residents

Nursing home residents with Alzheimer’s disease or a related dementia have better outcomes when their facility specializes in dementia care, according to an NIA-funded study. However, in most nursing homes in the United States, specialized care for people with dementia is limited. Findings from the study were published in Health Affairs.

Dementia prevalence is expected to increase over the coming decades, and with it, the need for specialized care in nursing homes is growing. Currently, fewer than 5% of all nursing home beds are in dementia special care units, and evidence on the quality of care they provide has been inconclusive. Overall, information about the availability of specialized dementia care in all U.S. nursing homes has been limited.

To address this gap, a research team led by scientists at the University of California, Irvine set out to determine how many nursing home residents with dementia — defined in this study as a person with a diagnosis of Alzheimer’s, a related dementia, or moderate to severe cognitive impairment — lived in a setting where they were in the majority. Next, they assessed whether the proportion of residents with dementia influenced the quality of care for those with the condition. The team analyzed facility and resident data provided by the Centers for Medicare & Medicaid Services (CMS). The analysis included 13,909 U.S. facilities serving nearly 3.2 million residents with dementia from 2017 to 2019.

The researchers began by grouping the nursing homes based on their proportion of residents with dementia. They found that most nursing homes had residents living with dementia, ranging from under 10% to over 90% of total residents, with the majority caring for between 31% and 80%, and only 4% of nursing homes caring almost exclusively for dementia residents.

Next, the researchers examined care quality measures, including CMS quality rankings. They found that nursing homes where more than 90% of residents have dementia seem to provide better dementia care than nursing homes with a lower proportion of residents with the condition. For example, hospitalization and emergency department admissions for residents with dementia dropped rapidly as the proportion of these residents increased. Also, facilities with the highest proportion (90% or more) of residents with dementia had significantly higher-skilled nursing hours per resident than those with lower percentages. Within these facilities, 35% had special dementia care units, compared to only 20% of the facilities with 60% to 90% of residents with dementia.

Taken together, these findings show that while there are people with dementia in most nursing homes, they may be less likely to receive specialized care in facilities where residents with dementia are not in the majority. Future research is needed to determine how to improve care, quality of life, and health outcomes for nursing home residents with Alzheimer’s or a related dementia. Addressing these questions may help inform ongoing efforts to establish staffing standards for nursing homes in the U.S., suggesting that different standards may be appropriate for supporting care for residents with dementia.

This research was supported by NIA grant AG066742.

These activities relate to NIH’s AD+ADRD Research Implementation Milestone 13.K, “Expand research leading to understanding of effectiveness and impacts of non-residential and residential care of PWD [people with dementia].”

Reference: Mukamel, DB, et al. Dementia care is widespread in US nursing homes; facilities with the most dementia patients may offer better care. Health Affairs. 2023;42(6), 795–803. doi: 10.1377/hlthaff.2022.01263.