New Study Shows Nursing Home Staffing Patterns Can Reduce Harmful Falls Among Residents

A new study has found that nursing homes with higher staffing levels report fewer injurious falls among long-stay residents. The study also found that facilities with insufficient staff levels are associated with increased falls.

Falls are one of the most common and serious safety concerns for older adults in long-term care settings, often leading to injury, loss of independence, and increased health care costs. Until now, large-scale evidence examining the impact of staffing patterns on fall-related injury rates in nursing homes has been limited.

The study, “Falls in the Nursing Home: The Impact of Staffing Levels and Agency Staff Use on Injurious Falls,” was published in the Journal of the American Medical Directors Association and analyzed data from more than 1.1 million Medicare beneficiaries across 11,183 nursing homes. Researchers examined how total staffing hours and the use of temporary agency staff were associated with injurious falls, using a benchmark of 2.45 certified nursing assistant hours per resident per day to define recommended staffing levels. Nearly 30% of nursing homes met the recommended CNA threshold, while 70.3% fell short.

Nursing homes that met CNA coverage and increased hours for both CNAs and registered nurses experienced significantly lower rates of injurious falls. For example, in well-staffed homes, each additional RN staffing hour was associated with nearly a 40% reduction in injurious falls.

In contrast, facilities that did not meet CNA staffing recommendations paradoxically showed higher rates of injurious falls as CNA hours increased. These findings suggest that simply adding hours without adequate overall staffing may not improve — and may worsen — outcomes.

The results highlight the complex relationship between staffing patterns and resident safety, suggesting that quality improvements through staffing enhancements may depend on broader resource availability and the overall staffing environment.

“Ensuring resident safety in nursing homes is a multifaceted challenge, and our study underscores the importance of thoughtful staffing strategies tailored to each facility’s baseline resources,” said Sarah Berry, MD, MPH, a co-author of the study and a senior scientist at Hebrew SeniorLife’s Hinda and Arthur Marcus Institute for Aging Research, where she advances the study of osteoporosis and falls. “Greater staffing — especially meeting recommended CNA and RN hours — can protect residents from injurious falls, but our findings show that simply increasing hours in under-resourced homes without addressing overall staffing shortages may not be enough.”

In addition to Berry, researchers included Jenna S. Khoja, MSc, researcher, Center for Bioethics, Harvard Medical School; Kylee G. MacLean, project director II, Marcus Institute, Hebrew SeniorLife; Yoojin Lee, MS, MPH, epidemiologist, Department of Epidemiology, Brown University School of Public Health; Richa Joshi, MS, research scientist, Center for Gerontology and Health Care Research, Brown University School of Public Health; Lori A. Daiello, PharmD, ScM, professor and investigator, Department of Health Services, Policy, and Practice, Brown University School of Public Health.

About Hebrew SeniorLife
Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching, and redefining the possibilities of aging. Hebrew SeniorLife cares for more than 4,500 seniors a day across seven campuses throughout Greater Boston. Locations include: Hebrew Rehabilitation Center-Boston and Hebrew Rehabilitation Center-NewBridge in Dedham; NewBridge on the Charles, Dedham; Orchard Cove, Canton; Simon C. Fireman Community, Randolph; Center Communities of Brookline, Brookline; Jack Satter House, Revere; and Leyland Community, Dorchester. Founded in 1903, Hebrew SeniorLife also conducts influential research into aging at the Hinda and Arthur Marcus Institute for Aging Research, which has a portfolio of more than $87 million, making it one of the largest gerontological research facilities in the U.S. in a clinical setting. It also trains more than 500 geriatric care providers each year. For more information about Hebrew SeniorLife, follow us on our blog, Facebook, Instagram, and LinkedIn.