7 Themes Driving Avoidable Nursing Home Placements Among Individuals Living with Dementia

A new qualitative study examines the preventable factors that lead to nursing home placements among people living with dementia, highlighting the unmet needs and systemic barriers that often drive these transitions. By exploring where support systems fall short, the study offers insights that can guide communities, caregivers, and nursing home administrators in improving dementia care and reducing unnecessary institutionalization.

Challenges in Accessing Support for Home Care

The study, “Unmet needs and nursing home placements in Black, Latino, and White people living with dementia,” is the first phase of a two-part mixed-methods project. Using in-depth, one-on-one interviews, researchers investigated the circumstances and barriers that contribute to avoidable nursing home placements. This phase focuses specifically on individuals who have already entered nursing homes, drawing on findings from two large facilities in urban New York City to better understand the unmet needs preceding placement.

Jasmine Travers Altizer, PhD, MHS, RN, FAAN, associate professor at New York University Rory Meyers College of Nursing

Study author Jasmine Travers Altizer, PhD, MHS, RN, FAAN, an associate professor at New York University Rory Meyers College of Nursing, notes that families interviewed for the study described strikingly similar obstacles. “Services were too expensive, insurance didn’t cover enough, there weren’t enough staff, available hours were too limited, or they simply didn’t know where to turn,” she says.

“For example, adult day centers can be valuable, but many operate from 9 a.m. to 2 p.m., which is difficult for working families to use. These experiences reflect larger system issues, such as Medicaid’s continued emphasis on institutional care and the uneven availability of home- and community-based services across states.”

One of the most striking findings was how often older adults and their families struggled to obtain even the most basic support at home. “The consistency of these challenges stood out,” she adds. “We also heard about new factors, such as gentrification, which disrupts the community networks that often surround and support older adults. As people are priced out of their homes and family stores have to close, older adults who remain have a smaller network to rely on thus leading to avoidable nursing home placements.”

The study identifies seven common themes that contribute to avoidable nursing home placements:

1. Assistance with activities of daily living and basic home maintenance: Many participants reported significant challenges in securing the necessary care for individuals living with dementia, citing difficulties accessing supportive services and affording needed assistance.
2. Resources and services: The varying accessibility and availability of community resources and services, and the quality of care provided, was another common challenge. For example, some participants couldn’t access services like meal programs because of complex insurance s
3. Treatment-related services: Participants cited barriers such as limited transportation options, scheduling conflicts, and difficulties using public transit—all of which made it harder to access essential treatment services, including medical appointments and prescription medications.
4. Socialization: Older adults living with dementia often experienced limited social interaction, with some becoming completely isolated from others. Some family members expressed concern that their loved ones felt lonely and emphasized the need for greater opportunities for social engagement and connection.
5. Individual preferences: Some individuals preferred not to receive some services and supports, such as individuals who preferred not to have assistance from home health aides.
6. Function of the home: Home safety emerged as another key theme, with the inability to make necessary modifications posing a major barrier to individuals with dementia remaining safely in their homes.
7. Equipped, available, and supported family: Family members reported a range of challenges in caring for individuals with dementia, including interpersonal strains and a lack of training or information about available resources to help reduce the burden on family care partners.

Lessons From the Study and Rethinking Care Access

The study provides important information and awareness about the changes that need to be made to reduce avoidable admissions. “Reducing avoidable admissions would allow nursing homes to focus staff and resources on residents who truly need institutional care, improving quality of care system-wide,” says Dr. Travers Altizer. She notes that this goal is especially urgent given the ongoing staffing shortages the senior care industry faces.

What might a solution look like? “Families need reliable, affordable home- and community-based services, such as home health aides, transportation, and respite care, paired with clearer guidance on navigating available resources,” Dr. Travers Altizer explains. “At a broader level, investment in the care workforce and expansion of programs like PACE and CAPABLE, along with more flexible Medicaid and Medicare benefits, would significantly improve access and help families keep their older adult family member at home.”

She notes that the study’s findings have already inspired the creation of IN-HOME, a new tool designed to identify unmet needs in real time—helping older adults and their families access support before a crisis leads to nursing home placement. Dr. Travers Altizer hopes to test IN-HOME in a commystems.unity-based study soon, which will examine how well it predicts nursing home placements and other health outcomes.

“Findings will guide implementation of IN-HOME in health and aging service systems, strengthen supports for older adults and families, and inform evidence-based policy to reduce institutionalization and promote aging in place,” she says. “Updates will be shared through our university channels and upcoming publications.”

Unnecessary nursing home placements put additional strain on the nursing home system, while preventing many older adults who wish to remain at home from doing so, often due to the seven key barriers identified in this study. “Many nursing home placements could be delayed or avoided altogether, allowing older adults to remain at home longer, safely and where many of them want to be,” explains Dr. Travers Altizer. With the right tools, supports, and policy changes that strengthen home- and community-based care, more individuals can age in place in ways that honor their preferences and preserve their independence.

Paige Cerulli

Paige Cerulli is a contributing writer to i Advance Senior Care.