Residents with Alzheimer’s and related dementias experience improved outcomes in nursing homes with dedicated dementia care, as reported by a study funded by the NIA. In the United States, such specialized care remains scarce across the majority of nursing homes. This study’s findings, featured in Health Affairs, underscore the growing necessity for targeted care as dementia prevalence is set to rise.
Currently, a mere fraction—less than 5%—of nursing home beds are within specialized dementia care units, with previous evidence regarding their care quality being mixed. Overall, comprehensive data on the prevalence of specialized dementia care in U.S. nursing homes have been scant.
To bridge this knowledge gap, a team spearheaded by University of California, Irvine researchers embarked on a quest to identify the proportion of nursing home residents with dementia, recognized here as individuals diagnosed with Alzheimer’s, related dementias, or exhibiting moderate to severe cognitive impairment, situated in environments where they are predominantly represented. Additionally, they examined how the percentage of residents with dementia within a facility impacts the quality of care they receive. Using facility and resident data from the Centers for Medicare & Medicaid Services (CMS), their analysis encompassed 13,909 U.S. facilities and approximately 3.2 million residents with dementia from 2017 to 2019.
The study initiated by categorizing nursing homes according to the percentage of residents diagnosed with dementia. It was observed that dementia-afflicted residents accounted for a spectrum from less than 10% to in excess of 90% of the total population across various facilities. The bulk of homes tended to manage a demographic comprising 31% to 80% individuals with dementia, whereas a scant 4% focused almost entirely on those with this condition.
Subsequently, the investigative team scrutinized quality of care indicators, utilizing CMS’s quality benchmarks. It emerged that homes with a dementia resident majority – above 90% – reportedly deliver superior care specific to dementia compared to homes with fewer such residents. Notably, instances of hospitalization and emergency room visits for dementia residents diminished considerably with the increase in their numbers within a facility. Moreover, homes with upwards of 90% dementia residents dedicated significantly more skilled nursing hours per resident than those with fewer dementia residents. Of these high-density dementia homes, 35% possessed specialized dementia care units, in stark contrast to just 20% in homes with a dementia population of 60% to 90%.
Collectively, this evidence indicates that while dementia patients are present in the majority of nursing homes, they are potentially less likely to access specialized care unless they represent a majority of the resident population. Further research is imperative to better the care, enhance the quality of life, and improve health outcomes for individuals with Alzheimer’s or related dementias in nursing facilities. Such inquiries could contribute valuable insights into the establishment of staffing requisites for U.S. nursing homes, proposing that tailored standards may be more suitable for optimizing care for residents with dementia.