Health care worker violence and impacts on health of institutionalized adrd patients

The National Institute on Aging awarded The RAND Corporation $809,762 on September 1, 2026, under the Aging Research program (CFDA 93.866) to conduct a five-year study examining the relationship between workplace violence against health care workers in skilled nursing facilities and health outcomes for institutionalized residents with Alzheimer's disease and related dementias.

RAND will link California state workers' compensation claims data—a previously unexamined source documenting incidents of health care worker violence—to patient-level Centers for Medicare and Medicaid Services administrative records spanning 2005–2024. The analysis will cover more than 1,000 California skilled nursing facilities and incorporate resident-level assessment data and high-frequency facility-level staffing data to identify risk factors for health care worker violence and measure its causal impacts on patient health. The study addresses a significant gap: while skilled nursing facilities have experienced a 30 percent rise in health care worker violence since 2011 and residents with Alzheimer's disease and related dementias comprise 58 percent of long-stay facility residents, systematic evidence linking staffing disruptions from violence incidents to patient outcomes has not been rigorously established.

Place of performance is Santa Monica, California 90401. The period of performance runs from September 1, 2026, through May 31, 2031. The assistance type is a Project Grant.

Abstract

Workplace violence against health care workers (HCW violence) is common and increasing. Skilled nursing facilities (SNFS) specifically have seen a 30% rise in HCW violence since 2011. Resulting absences may worsen staffing shortages, especially as demand for long-term care grows. Residents with alzheimer's disease and related dementias (ADRD), who comprise 58% of long-stay SNF residents, may be especially vulnerable to harm from staffing disruptions due to their need for continuous care. These individuals may also affect the risk of HCW violence, as ADRD can lead to aggressive behavior, yet ADRD census and other aspects of patient mix have not been directly studied as risk factors for HCW violence. There is little rigorous evidence on how HCW violence affects health of SNF residents. Older adults in nursing homes, particularly those with ADRD diagnoses, often have complex medical and cognitive needs requiring consistent staffing and attention, and staffing is an important predictor of patient safety and health outcomes in nursing homes. HCW violence thus seems likely to harm SNF residents. However, we lack systematic evidence about the patient health consequences of HCW violence or its risk factors due largely to data limitations. We propose a 5-year study that will link state workers' compensation claims-a previously unexamined source of data on incidents of HCW violence-to patient-level CMS administrative records. We will use this unique linked dataset to provide a comprehensive analysis of HCW violence in SNFS in california (over 1,000 facilities) for over 20 years (2005-2024). Resident-level assessment data and high-frequency facility-level staffing data will enable US to study risk factors for HCW violence and its impacts on patients. We will use quasi-experimental methods to provide the most credible causal evidence to date on how HCW violence affects resident health, and on the role that staffing changes play as a mechanism for these impacts. Impacts of HCW violence on the health of residents with ADRD will be a central focus of the study, since these residents may be especially vulnerable to harms from staffing disruptions. We will carry out this research via three specific aims: aim 1: develop facility-level measures of HCW violence and injury rates in SNFS and describe organizational, facility-level, and community factors associated with HCW violence. Aim 2: estimate the effect of HCW violence on SNF residents' health, cognition, and mood. Aim 3: examine staffing as mechanism for HCW violence impacts on resident health and estimate downstream effects on mortality, hospital utilization, and associated medicare spending. This study will provide new evidence on risk factors for HCW violence and impacts of HCW violence on SNF residents. Our findings may inform SNF staffing regulations and the design of interventions to improve ADRD patient outcomes through violence prevention. We will also develop new methods for studying HCW violence that can be used in other states and health care facilities, establishing a foundation for future research.