ArticleJournal of the American Geriatrics Society2023
Severe neighborhood deprivation and nursing home staffing in the United States.
Article in Journal of the American Geriatrics Society, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 2 of them syntheses that pooled it.
What it found
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Who cites it
12 citing papers in PubMed, 2 syntheses or guidelines pooled it, 21 citations in OpenAlex.
- Factors associated with the variation in drug prescription of antipsychotics in long-term care facilities: a systematic review.BMC geriatrics · 2025Pooled it
- Pooled it
- Staffing Audit Outcomes Among California Skilled Nursing Facilities, Prior to and After COVID-19-Related Staffing Waivers.Journal of the American Medical Directors Association · 2026Article
- Disparities in Physical Function and Rehabilitation Utilization: A Cross-sectional Study of Patients Hospitalized for Acute Medical Illness.Journal of general internal medicine · 2026Article
- Neighborhood Deprivation and Days Spent at Home After Fall-Related Hip Fracture.JAMA network open · 2025Article
- Financial performance of rural and urban nursing homes: A comparative analysis.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2025Article
- The dementia care workforce: Essential to care but large research gaps exist.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2025Review
- Association of Racial and Ethnic Composition with Staff Levels in Nursing Homes: 2013-2019.Journal of the American Medical Directors Association · 2025Article
- How Neighborhood Social Deprivation Is Associated With Nursing Home Quality: A Structure, Process, Outcome Model.Innovation in aging · 2025Article
- Staffing and Antipsychotic Medication Use in Nursing Homes and Neighborhood Deprivation.JAMA network open · 2024Article
- Nurse staffing disparities in nursing homes: Effects of community distress level and COVID-19.Nursing outlookObservational
- Comprehensive Dementia Care Models: State of the Science and Future Directions.Research in gerontological nursingReview
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 5 institutions in 1 country.
Funding
Abstract
backgroundLow nursing home staffing in the United States is a growing safety concern. Socioeconomic deprivation in the local areas surrounding a nursing home may be a barrier to improving staffing rates but has been poorly studied. Thus, the objective of this paper was to assess the relationship between neighborhood deprivation and nursing home staffing in the United States.
methodsThis cross-sectional study used 2018 daily payroll-based staffing records and address data for 12,609 nursing homes in the United States linked with resident assessment data. Our primary exposure of interest was severe economic deprivation at the census block group (neighborhood) level, defined as an area deprivation index score ≥85/100. The primary outcome was hours worked per resident-day among nursing home employees providing direct resident care. Marginal linear regression models and generalized estimating equations with robust sandwich-type standard errors were used to estimate associations between severe neighborhood deprivation and staffing rates.
resultsCompared to less deprived neighborhoods, unadjusted staffing rates in facilities located within severely deprived neighborhoods were 38% lower for physical and occupational therapists, 30% lower for registered nurses (RNs), and 5% lower for certified nursing assistants. No disparities in licensed practical nurse (LPN) staffing were observed. In models with state-level and rurality fixed effects and clustered on the county, a similar pattern of disparities was observed. Specifically, RN staffing per 100 resident-days was significantly lower in facilities located within severely deprived neighborhoods as compared to those in less deprived areas (mean difference: 5.6 fewer hours, 95% confidence interval [CI] 4.2-6.9). Disparities of lower magnitude were observed for other clinical disciplines except for LPNs.
conclusionsSignificant staffing disparities were observed within facilities located in severely deprived neighborhoods. Targeted interventions, including workforce recruitment and retention efforts, may be needed to improve staffing levels for nursing homes in deprived neighborhoods.
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Registered trials
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