Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun;42(6):795-803.
doi: 10.1377/hlthaff.2022.01263.

Dementia Care Is Widespread In US Nursing Homes; Facilities With The Most Dementia Patients May Offer Better Care

Dana B Mukamel  1 , Debra Saliba  2 , Heather Ladd  3 , R Tamara Konetzka  4
Affiliations

Dementia Care Is Widespread In US Nursing Homes; Facilities With The Most Dementia Patients May Offer Better Care

Dana B Mukamel et al. Health Aff (Millwood). 2023 Jun.

Abstract

More than three million US nursing home residents were diagnosed with Alzheimer's disease and related dementias (ADRD) between 2017 and 2019. This number is expected to increase as the population ages and ADRD prevalence increases. People with ADRD require specialized care from trained staff. This study addressed two questions: Are residents with ADRD concentrated in nursing homes where they are the majority? If not, what are the implications for their quality of care and life? We answered the first question by determining the ADRD census for each nursing home in the country during the period 2017-19. Using the Minimum Data Set and Medicare claims, we compared characteristics of nursing homes with high and low ADRD census along several dimensions, including staffing, resident outcomes, and resident characteristics. We found that residents with ADRD were dispersed throughout all nursing homes, with fewer than half residing in nursing homes where residents with ADRD accounted for 60-90 percent of the census. Furthermore, only facilities exceeding 90 percent of residents with ADRD seemed to offer better care. These findings raise concerns about the quality of care and life for the majority of residents with ADRD, suggesting that current National Institutes of Health dementia research initiatives and the Biden administration's policies to improve nursing home care should be coordinated.

PubMed Disclaimer

Figures

Exhibit 1
Exhibit 1
Distribution of US nursing homes by Alzheimer’s disease and related dementias (ADRD) or cognitive impairment (CI) deciles, 2017–19 SOURCE Authors’ analysis of national Minimum Data Set 2017–19 data.
Exhibit 2
Exhibit 2
Daily hospitalization, emergency department, and death rates per 1,000 resident-days, US national nursing home residents, 2017–19 SOURCE Authors’ analysis of National Minimum Data Set and Medicare claims 2017–19 data. NOTE Values shown are averages calculated over all nursing homes in each Alzheimer’s disease and related dementias (ADRD) or cognitive impairment (CI) decile.
See this image and copyright information in PMC

References

    1. 2022 Alzheimer’s disease facts and figures. Alzheimers Dement. 2022;18(4):700–89. - PubMed
    1. Bunn F, Burn AM, Goodman C, Rait G, Norton S, Robinson L, et al. Comorbidity and dementia: a scoping review of the literature. BMC Med. 2014;12:192. - PMC - PubMed
    1. Ishii S, Streim JE, Saliba D. A conceptual framework for rejection of care behaviors: review of literature and analysis of role of dementia severity. J Am Med Dir Assoc. 2012;13(1):11–23.e1–2. - PubMed
    1. Ballard C, Corbett A, Orrell M, Williams G, Moniz-Cook E, Romeo R, et al. Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: a cluster-randomised controlled trial. PLoS Med. 2018;15(2):e1002500. - PMC - PubMed
    1. Castle NG, Engberg J. Staff turnover and quality of care in nursing homes. Med Care. 2005;43(6):616–26. - PubMed

Publication types