Where You Are Matters: Neighborhood Impacts on Nursing Home Staffing Levels

OBJECTIVES: Inadequate staffing levels in US nursing homes (NHs) remain an ongoing concern affecting the quality of care. Socioeconomic deprivation in the areas surrounding NHs may affect their ability to maintain optimal staffing levels, but this relationship remains understudied. This study aimed to examine the associations between neighborhood deprivation and NH staffing levels. DESIGN: Cross-sectional observational study using secondary data analysis. SETTING AND PARTICIPANTS: A national NH-level dataset (N = 10,360) was constructed by merging 3 publicly available data sources: the 2023 Area Deprivation Index from the Neighborhood Atlas, the 2022 Nursing Home Archived Data from the Centers for Medicare & Medicaid Services, and the 2022 LTCFocus from Brown University. METHODS: Multiple linear regression analyses were performed while controlling for other NH facility and resident characteristics. RESULTS: The findings showed that higher neighborhood deprivation was significantly associated with fewer hours per resident day for registered nurses (β = -0.001, P < .001) and total nursing staff (β = -0.001, P < .001) on both weekdays and weekends. However, no significant associations were found between neighborhood deprivation and hours per resident day for licensed practical nurses or certified nursing assistants. CONCLUSIONS AND IMPLICATIONS: This study highlights disparities in nursing staff levels in more socioeconomically deprived areas, particularly among registered nurses. Given their broad range of responsibilities and central role in providing clinical care, registered nurses play a critical role in NHs. These findings underscore the need for targeted policy interventions to ensure adequate registered nurse staffing levels in low-resourced communities.