The quality of care for nursing home residents with Alzheimer's disease and related dementias is best when they are in the majority, but most facilities also accommodate a heterogeneous population, where specialized staff training is limited, according to a study led by the University of California, Irvine.

"Recognizing and managing the complex medical conditions and behavioral symptoms of residents with ADRD require enhanced knowledge among staff. These findings raise significant concerns regarding the level of care and quality of life for the majority of these people, highlighting the urgent need for a higher level of care for them," said Dana Mukamel, corresponding author and UCI professor of medicine.

Findings, recently published in the June issue of the journal Health Affairs, are based on an analysis of 13,909 facilities between 2017 and 2019. Data from the Centers for Medicare & Medicaid Services were analyzed to assess facilities with high and low ADRD populations, staffing levels, quality of care and health outcomes for 7.6 million residents, 42% of whom were diagnosed with ADRD or cognitive impairment.

Researchers discovered that ADRD residents were dispersed throughout all nursing homes, with fewer than half in facilities where they accounted for 60-90% of the population. It was also revealed that fewer than 5% of nursing home beds are in dementia special care units, and only facilities that had an ADRD population exceeding 90% seemed to offer better care.

"This study aimed to address the gaps in the current literature regarding the concentration of ADRD residents in nursing homes, and the implications that has on their quality of care," Mukamel said. "Our findings highlight the need for specialized training and raise important policy issues that must be addressed."

The National Alzheimer's Project Act of 2011 has prompted increased investment in research by the National Institute on Aging, and federal policies to improve nursing home care through enhanced staffing standards are expected to benefit all residents. However, the lack of training based on population mix raises concerns about ensuring quality and safety for those with ADRD.

"While the prevalence of ADRD is expected to grow in coming decades, those residing in nursing homes represent the majority in only a few facilities," Mukamel said. "Efforts to inform optimal care practices, staffing requirements and training require investments in research, policy and innovation. Continued focus and collaboration are essential to drive progress and improve the care, quality of life and health outcomes for this vulnerable population."

The team also included researchers Deborah Saliba, UCLA Anna & Harry Borun Endowed Chair in Geriatrics and Gerontology, and associate director for education in the Los Angeles Veterans Affairs Healthcare System; Heather Ladd, UCI general internal medicine research senior statistician and data analyst; and Tamara Konetzka, the Louis Block Professor of Public Health Sciences at the University of Chicago.