Staffing of Qualified Social Workers and Nursing Home Quality of Care.

Importance: Nursing homes provide 24-hour care for more than 1.2 million US residents with complex medical and psychosocial needs. Social workers play a role in supporting person-centered care, yet many facilities lack adequate social worker coverage, and evidence associating qualified social worker staffing with quality outcomes remains limited. Objective: To examine the association between staffing of qualified social workers and nursing home quality outcomes, with attention to facilities serving residents with Alzheimer disease and related dementias. Design, Setting, and Participants: This facility-level cohort study used a synthetic difference-in-differences design with staggered adoption to analyze 2491 US nursing homes from January 1, 2017, to December 31, 2021, comparing facilities that employed a qualified social worker during 2018 to 2021 with those that had not yet employed one. Data analysis was conducted between October 1, 2024, and December 29, 2025. Exposure: Employment of a qualified social worker, defined as any facility with an annual mean of greater than 0 daily hours worked by employed (noncontract) qualified social workers. Main Outcomes and Measures: The primary outcome was the proportion of residents restrained. Secondary outcomes include hospitalizations per resident-year, 30-day rehospitalization among postacute admissions, and successful discharge to the community within 100 days. Results: The analysis included 2491 facilities. The mean (SD) resident age was 79.0 (5.9) years, and the mean (SD) share of female admissions was 0.58 (0.10). The mean (SD) Medicaid share was 0.61 (0.21), and the mean (SD) Medicare share was 0.14 (0.11). Qualified social worker staffing was associated with a 0.3-percentage point reduction in restraint use (95% CI, -0.6 to -0.0 percentage points), 46% of the 2017 mean. No significant associations were observed for hospitalizations, rehospitalization rates, or discharges. In subgroup analyses, facilities with above-median dementia prevalence had 0.5-percentage point lower restraint use (95% CI, -0.9 to -0.1 percentage points), with no association in low-prevalence facilities. Conclusions and Relevance: In this cohort study of US nursing homes, employment of a qualified social worker was associated with reduced restraint use, particularly in facilities with higher dementia prevalence. These findings support policies to expand social work capacity to promote person-centered, less-restrictive care in nursing homes.