Table 1.
Changes in the Long-Stay Nursing Home Resident Population, Facility Characteristics, and Use of Antipsychotic or Sedative Medications between 2011 and 2016
| Population Characteristics | Antipsychotic Use | Sedative-Hypnotic Use | ||||||
|---|---|---|---|---|---|---|---|---|
| 2011 | 2016 | 2011 (%) | 2016 (%) | Relative Change (%) | 2011 (%) | 2016 (%) | Relative Change (%) | |
| Resident-level variables | n = 1,116,476 | n = 1,119,889 | 22.9 | 16.2 | −29.3 | 6.3 | 3.6 | −42.9 |
| Male | 30.8% | 33.5% | 24.8 | 17.4 | −29.8 | 6.7 | 4.0 | −40.3 |
| Female | 69.2% | 66.5% | 22.0 | 15.6 | −29.1 | 6.1 | 3.4 | −44.3 |
| White | 78.0% | 75.9% | 23.2 | 16.8 | −27.6 | 6.5 | 3.7 | −43.1 |
| Black | 13.1% | 14.0% | 21.0 | 13.4 | −36.2 | 4.9 | 2.8 | −42.9 |
| Hispanic | 4.7% | 5.3% | 25.9 | 17.2 | −33.6 | 7.6 | 4.9 | −35.5 |
| Asian/other | 4.2% | 4.8% | 19.6 | 13.2 | −32.7 | 5.8 | 3.2 | −44.8 |
| Medicaid | 68.7% | 71.8% | 22.8 | 16.4 | −28.1 | 6.2 | 3.4 | −45.2 |
| Physical aggression | 5.4% | 4.1% | 48.2 | 38.2 | −20.7 | 4.3 | 2.5 | −41.9 |
| Verbal aggression | 8.4% | 7.0% | 45.1 | 35.0 | −22.4 | 6.0 | 3.5 | −41.7 |
| Bipolar disorder | 3.3% | 4.1% | 66.6 | 60.7 | −8.9 | 10.5 | 6.5 | −38.1 |
| Dementia | 44.8% | 46.1% | 29.9 | 21.0 | −29.8 | 4.4 | 2.4 | −45.5 |
| Anxiety | 23.0% | 29.5% | 33.6 | 25.1 | −25.3 | 9.9 | 5.5 | −44.4 |
| Depression | 49.7% | 50.5% | 27.0 | 19.9 | −26.3 | 7.3 | 4.3 | −41.1 |
| Facility-level variables | n = 15,530 | n = 15,524 | ||||||
| For-profit | 69.1% | 69.6% | 23.8 | 16.8 | −29.4 | 6.8 | 3.9 | −42.6 |
| Government | 6.6% | 7.4% | 22.3 | 16.8 | −24.7 | 5.2 | 3.4 | −34.6 |
| Non-profit | 24.3% | 23.0% | 20.3 | 14.3 | −29.6 | 5.0 | 2.9 | −42.0 |
| Rural | 25.1% | 23.1% | 23.3 | 17.2 | −26.2 | 6.2 | 3.7 | −40.3 |
| Urban | 74.9% | 76.9% | 22.7 | 15.9 | −30.0 | 6.3 | 3.6 | −42.9 |
| High bed count | ≥172 beds | ≥170 beds | 23.2 | 16.7 | −28.0 | 5.8 | 3.3 | −43.1 |
| Low bed count | ≤96 beds | ≤95 beds | 22.2 | 16.1 | −27.5 | 6.0 | 3.5 | −41.7 |
| High Medicaid | ≥77% Medicaid | ≥76% Medicaid | 26.7 | 19.7 | −26.2 | 6.6 | 3.9 | −40.9 |
| Low Medicaid | ≤55% Medicaid | ≤53% Medicaid | 19.3 | 13.6 | −29.5 | 5.8 | 3.4 | −41.4 |
| Acuity-adjusted average RN min. per resident day | ||||||||
| Highest quartile | 34 min | 50 min | 21.1 | 14.5 | −31.3 | 5.1 | 3.0 | −41.2 |
| Second highest quartile | 21 min | 33 min | 21.9 | 15.5 | −29.7 | 5.8 | 3.3 | −43.1 |
| Second lowest quartile | 17 min | 26 min | 23.1 | 16.3 | −29.4 | 6.6 | 3.8 | −42.4 |
| Lowest quartile | 12 min | 17 min | 25.4 | 18.3 | −28.0 | 7.5 | 4.4 | −41.3 |
| Acuity-adjusted average LPN hours & min. per resident day | ||||||||
| Highest quartile | 1.42 h | 1.57 h | 23.3 | 16.3 | −30.0 | 6.9 | 4.1 | −40.6 |
| Second highest quartile | 0.98 h | 1.16 h | 23.5 | 16.7 | −28.9 | 6.6 | 3.8 | −42.4 |
| Second lowest quartile | 0.87 h | 0.93 h | 22.8 | 16.0 | −29.8 | 6.2 | 3.5 | −43.5 |
| Lowest quartile | 0.55 h | 0.57 h | 21.8 | 15.6 | −28.4 | 5.3 | 3.0 | −43.4 |
| Acuity-adjusted average CNA hours & min. per resident day | ||||||||
| Highest quartile | 3.11 h | 3.18 h | 22.9 | 16.1 | −29.7 | 6.8 | 3.8 | −44.1 |
| Second highest quartile | 2.48 h | 2.53 h | 22.3 | 15.3 | −31.4 | 6.1 | 3.7 | −39.3 |
| Second lowest quartile | 2.17 h | 2.22 h | 22.6 | 15.9 | −29.6 | 5.9 | 3.4 | −42.4 |
| Lowest quartile | 1.79 h | 1.83 h | 23.6 | 17.3 | −26.7 | 6.2 | 3.5 | −43.5 |
| Acuity-adjusted average total RN/LPN/CNA hours per resident day | ||||||||
| Highest quartile | 4.40 h | 4.90 h | 22.5 | 15.7 | −30.2 | 6.4 | 3.7 | −42.2 |
| Second highest quartile | 3.62 h | 4.01 h | 22.4 | 15.3 | −31.7 | 6.1 | 3.6 | −41.0 |
| Second lowest quartile | 3.25 h | 3.58 h | 22.8 | 16.1 | −29.4 | 6.3 | 3.5 | −44.4 |
| Lowest quartile | 2.78 h | 3.05 h | 23.7 | 17.5 | −26.2 | 6.3 | 3.6 | −42.9 |
Note: Authors’ analysis of Minimum Data Set, Certification and Survey Provider Enhanced Reports (CASPER), and Nursing Home Compare (acuity-adjusted staffing) data, 2011 and 2016. Ownership (For-Profit, Government, Non-Profit), Rural, and Urban variables refer to the percentage of individuals within that classification, as opposed to the percentage of facilities with that classification. CNA = certified nurse assistant; LPN = licensed practical nurse; RN = registered nurse.