Table 1.

Challenges in Nursing Home Research

Unique Challenge	Suggested Strategies	Advantages	Disadvantages
Recruitment of nursing homes	Partnering with administrators	Building relationships	Time consuming for principal investigator
Recruitment of subjects through surrogate consent	Letter, phone call, and group meeting contacts with surrogates	Higher recruitment rates	Time consuming for research staff
Engagement of nursing home staff	Educational sessions, professional incentives, and personal incentives	Higher recruitment and retention rates, improved protocol adherence	Cost, time consuming for research staff, time consuming for nursing staff
High turnover of nursing home staff	Repeated in-service sessions	Improved protocol adherence	Time consuming for research staff
Surveillance for outcomes and adverse events	Educational sessions, professional incentives, and personal incentives	Improved outcome detection	Cost, time consuming for research staff, time consuming for nursing staff
High attrition rate of participants	Increase recruitment of participants	Sustain power of study	Increase need for resources of research personnel