Strengthening Workforce Stability in Dementia Care: The Role of Scheduling, Training, and Benefits

• In Event: The Direct Care Workforce: Recruitment, Retention, and Labor Market Dynamics

Abstract

The growing prevalence of dementia and the substantial care needs of affected older adults have intensified demand for a stable long-term care workforce. Nursing homes (NHs) and assisted living (AL) communities provide care for more than one-third of individuals with the highest dementia-related needs, yet these settings continue to face persistent staff shortages and high turnover across direct care workers (DCWs), registered nurses (RNs), and licensed practical nurses (LPNs). High turnover disrupts care continuity and has been linked to poorer quality outcomes, underscoring the need to identify factors that can strengthen workforce stability. Prior studies show that facility characteristics, such as for-profit ownership, larger size, and chain affiliation, are associated with higher turnover. However, there is limited evidence on how modifiable organizational factors affect retention across staff roles and settings, and whether individual retention translates into facility-level turnover.This study fills this gap by examining how modifiable organizational characteristics, including dementia care training, scheduling practices, and compensation and benefits, shape employees’ job retention. We defined job retention as a binary outcome indicating whether staff are willing to remain in their position for more than one year (1 = >1 year; 0 = ≤1 year). We use data from the National Dementia Workforce Study staff survey linked with Area Health Resources Files (county-level characteristics) and Nursing Home Compare (facility-level characteristics and turnover rates).Principal Component Analysis (PCA) was used to construct composite measures of training, scheduling, and benefits. These components were incorporated into multivariable logistic regression models to estimate associations with job retention, adjusting for employee demographics and facility- and county-level characteristics. Analyses were conducted separately for NHs and AL communities, with subgroup analyses by staff role (RNs, LPNs, DCWs). Survey weights were applied to ensure national representativeness. In NHs, we additionally examined the association between retention and facility-level turnover using linear regression.PCA indicates that the benefits component is driven primarily by insurance-related benefits and retirement plans; the training component captures dementia-related skills with limited differentiation; and the scheduling component reflects work stability and predictability. In NHs, higher scheduling stability was associated with greater odds of retention (odds ratio [OR], 3.76; 95% CI, 1.30-10.86), as were more comprehensive benefits (OR, 2.92; 95% CI, 1.05-8.18). No statistically significant associations were observed for LPNs or DCWs, nor for training across any staff group. In AL settings, results were generally null across domains and roles. At the facility level, no significant association was observed between retention and turnover in NHs (β = 16.98 for all nurses), likely reflecting limited statistical power due to the small sample size.These findings suggest that scheduling stability and benefits may improve retention among RNs in NHs, but effects are not consistent across staff roles or care settings. The absence of associations in AL and at the facility level highlights the need for further investigation. Future work will incorporate additional waves of NDWS data to improve precision and better understand how modifiable organizational practices influence workforce stability in dementia care.

Author

• Fangli Geng, Brown University
  Presenting Author