A new study found that increasing staffing hours of registered nurses in assisted living communities led to a 53% decrease in injury-related emergency department visits by residents living with Alzheimer’s disease and related dementias.
Researchers from several higher education institutions, led by the Center for Health Statistics at the University of Massachusetts Lowell, conducted a retrospective study of 12,144 Medicare beneficiaries with ADRD living in 455 assisted living communities in Ohio between 2007 and 2015. They used 122,700 person-months to study the link between changes in nursing staff hours per resident day and ED visits. Their findings were published recently in JAMDA–The Journal of Post-Acute and Long-Term Care Medicine.
The investigators found that an increase in one RN hour per resident day was associated with a significant decrease in injury-related ED visits among assisted living residents with ADRD. On average, they reported, median staff hours increased slightly during the study timeframe, from 0.96 to 1.17 hours for personal care aides and from 1.34 to 1.69 hours for total nursing staff.
The authors found substantial variability among assisted living communities in their staffing models; some employ multiple RNs and licensed practical nurses to manage higher resident needs, whereas other communities provide low hours of care provided mostly by LPNs.
Although all types of nursing staff provide surveillance and safety oversight to prevent falls and injuries in assisted living communities, the researchers said, RNs are qualified to conduct physical assessment to determine whether an injury is significant enough to warrant a trip to the ED.
In addition, the authors noted, RNs may influence the likelihood of injury in the first place as well as decisions to transfer a resident to the ED by overseeing care planning, fall and injury risk assessments, medication management and early identification of changes in a resident’s overall condition.
Although more than 32% of assisted living residents have Alzheimer’s disease or a related dementia, and approximately 77% need assistance with bathing and 26% need assistance with eating, only 42% of assisted living communities had an RN on site in 2018, according to the study. (Research released in December 2022 from the federal government indicates that 42% of assisted living residents had dementia diagnoses, 64% needed assistance with bathing and 22% needed assistance with eating in 2020. That report did not indicate a level of RN staffing in assisted living.)
Individuals living with ADRD who reside in assisted living are at increased risk of injury-related ED visits when compared with residents without ADRD, according to the authors. In general, ED visits among older adults are associated with functional decline, nursing home admission and mortality, the authors noted. The most common causes of injuries among older adults are falls, but injuries also occur as a result of accidents, abuse and medication errors, they said.
Improved data systems are needed to capture both staffing levels and resident outcomes for assisted living communities to better inform staffing policies and recommendations for assisted living communities, the researchers said.
