Effects of Structural Workforce Interventions on Resident and Staff Outcomes in Long-Term Care Facilities: A Rapid Living Systematic Review

OBJECTIVES: Workforce interventions may relieve the growing demand for long-term care (LTC) homes, but their effectiveness in improving resident care remains unclear. We evaluated the impact of LTC home staffing interventions designed to facilitate organizational change at the team level and examined barriers and facilitators to implementation. DESIGN: We systematically searched MEDLINE, Embase, Cochrane Central, Cochrane Reviews, CINAHL, and Web of Science from inception to January 26, 2025. SETTING AND PARTICIPANTS: Randomized controlled trials of staffing interventions in LTC homes were included. METHODS: We conducted a rapid living systematic review with random effects meta-analyses, when possible. Risk of bias was assessed using Cochrane RoB 1.0, and certainty was assessed with Grading of Recommendations Assessment, Development and Evaluation. Barriers and facilitators were thematically analyzed. RESULTS: Eleven trials contributed to intervention effects. Skill-mix adjustment may have reduced resident hospitalizations [risk ratio (RR), 0.68; 95% CI, 0.51-0.91; low certainty]. For clinical health indicators (RR, 0.90; 95% CI, 0.72-1.13) and mortality (RR, 1.16; 95% CI, 0.88-1.54), the effects were small and uncertain. For quality of life (QoL) measures, there was little to no effect (standardized mean difference, -0.10; 95% CI, -0.22 to 0.03; moderate certainty). Studies involving family and volunteer integration in the LTC workforce showed little to no difference in QoL, and the clinical impacts were unknown. Certainty of evidence ranged from moderate to very low due to high risk of bias caused by deviations from intended interventions and selective outcome reporting. Staffing shortages and low fidelity were common barriers to implementation. The most common facilitators were staff engagement in the intervention design and structured training. CONCLUSIONS AND IMPLICATIONS: Skill-mix adjustments may reduce hospitalizations in LTC, but effects on other outcomes remain uncertain. Moderate-certainty evidence did not show QoL improvements. Future trials should prioritize resident-important outcomes and report intervention implementation and contextual factors.