A new study has found that nursing homes with higher staffing levels tend to report fewer injurious falls among long-stay residents, highlighting the importance of adequate workforce support in long-term care settings. Conversely, facilities operating with insufficient staffing were associated with increased rates of falls, suggesting that staffing shortages may directly impact resident safety. These findings reinforce growing concerns about how workforce capacity influences the quality of care in nursing homes.
Falls remain one of the most common and serious safety issues affecting older adults in long-term care. They frequently lead to physical injury, reduced independence, and a decline in overall wellbeing, while also contributing to rising healthcare costs. Despite the significance of this issue, large-scale research exploring how staffing patterns affect fall-related injuries in nursing homes has been relatively limited until now.
The study, titled “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. It examined data from more than 1.1 million Medicare beneficiaries across 11,183 nursing homes. Researchers focused on the relationship between total staffing hours, the use of temporary agency staff, and rates of injurious falls. A benchmark of 2.45 certified nursing assistant (CNA) hours per resident per day was used to define recommended staffing levels, with nearly 30% of facilities meeting this threshold and over 70% falling below it.
Findings showed that nursing homes meeting recommended CNA staffing levels, alongside increased hours for both CNAs and registered nurses, experienced significantly lower rates of injurious falls. In well-staffed facilities, each additional hour of registered nurse coverage was linked to nearly a 40% reduction in such incidents. This suggests that both the quantity and skill mix of staff play a crucial role in protecting residents from harm.
However, the study also revealed a more complex pattern in under-resourced facilities. Among nursing homes that did not meet recommended CNA staffing levels, increases in CNA hours were paradoxically associated with higher rates of injurious falls. This indicates that simply adding staffing hours without addressing broader systemic shortages or organisational challenges may not lead to improved outcomes and could even have unintended consequences.
Overall, the results underscore the nuanced relationship between staffing patterns and resident safety. Effective improvements depend not only on increasing staff numbers but also on ensuring adequate baseline resources and a balanced staffing structure. As co-author Sarah Berry, MD, MPH, noted, ensuring resident safety requires tailored staffing strategies. While meeting recommended CNA and RN levels can significantly reduce harmful falls, addressing wider staffing shortages and resource gaps remains essential for meaningful and sustained improvements in care quality.
More information: Jenna S. Khoja et al, Falls in the Nursing Home: The Impact of Staffing Levels and Agency Staff Use on Injurious Falls, Journal of the American Medical Directors Association. DOI: 10.1016/j.jamda.2025.106083
Journal information: Journal of the American Medical Directors Association Provided by Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research
