Association Between Long-Term Care Facility Staffing Levels and Antipsychotic Use in US Long-Term Care Facilities

  • Victoria Chappell
    Department of Psychiatry, Queen's University, Providence Care-Mental Health Services, Kingston, ON, Canada
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  • Julia Kirkham
    Department of Psychiatry, Hotchkiss Brain Institute, and O'Brien Institute for Public Health, Calgary, AB, Canada

    Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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  • Dallas P. Seitz
    Address correspondence to Dallas P. Seitz, MD, PhD, Cumming School of Medicine, University of Calgary, Room 2919 Health Sciences Centre, 3330 Hospital Drive NW, Calgary AB T2N 4N1, Canada.
    Department of Psychiatry, Queen's University, Providence Care-Mental Health Services, Kingston, ON, Canada

    Department of Psychiatry, Hotchkiss Brain Institute, and O'Brien Institute for Public Health, Calgary, AB, Canada

    Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Published:August 01, 2022DOI:



      Inappropriate use of antipsychotics is an indicator of quality of care in long-term care (LTC) facilities. There is evidence to suggest that staffing levels in LTC may be associated with the rates of inappropriate antipsychotic use. This study sought to examine the association between staffing and antipsychotic prescribing in LTC facilities.


      Cross-sectional study investigated the association between reported staffing levels and the frequency of inappropriate antipsychotic prescribing at US LTC facilities between 2016 and 2018.

      Setting and Participants

      Data from the Nursing Home Compare and LTCFocus datasets were linked, which contain information from the Minimum Data Set database on facility characteristics and staffing measures from the Payroll-Based Journal system. A final sample set of 10,436 facilities was used.


      Descriptive statistics were calculated for all variables of interest. An unadjusted linear correlation analysis and linear regression were performed. Potential confounders were investigated by comparison across low-vs high-staffing facilities where adjusted for in regression analyses.


      The mean staff level for the facilities was identified as 3.69 (SD = 0.67) staffing hours per patient per day, and the mean antipsychotic use rate across all facilities was 15.24% (SD = 8.62%). There was a 0.75% decrease in inappropriate antipsychotic prescribing per unit increase in overall staff-to-patient ratio. When looking at staffing types, a 3.09% decrease in inappropriate antipsychotic prescribing was observed per unit increase in licensed staff hours. More specifically, we saw a 2.25% decrease per unit increase in RN staffing hours, a 1.83% decrease per unit increase in LPN staffing hours, and nursing aide staffing hours were not associated with antipsychotic use.

      Conclusions and Implications

      These findings provide support for policy-based interventions to decrease antipsychotic use in LTC facilities by improving staffing skill mix and staffing levels. The results may also inform nursing staff education and training on antipsychotic prescribing practices.


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