Nurse practitioners have become an increasingly integral part of nursing home care over the last decade, and rightfully so, researchers have found. NPs’ involvement can significantly improve end-of-life care outcomes for residents with Alzheimer’s disease and related dementias (ADRD), according to the results of a new study in JAMA Health Forum.
Specifically, NPs were able to reduce hospitalization rates and increase hospice use for residents with ADRD in their last 30 days of life. Those benefits, however, were shrunk by state regulations on the scope of care NPs are allowed to provide.
“Our findings suggest that some of the restrictions that states put on NP scope of practice may influence how NPs provide care to nursing home residents with dementia at end-of-life,” said researcher Elizabeth White, PhD, assistant professor of health services, policy and practice at Brown University. “For example, when a state restricts NPs from signing Do Not Resuscitate orders, that can serve as a barrier to advance care planning and could contribute to unnecessary hospitalizations at the end of life.”
In the study of more than 330,000 nursing home residents with ADRD, nurse practitioners reduced hospitalizations overall when they were extensively involved in care. The reduction varied by state, however — reaching 1.76% in states where they had full authority to practice and only 0.43% in states where they had more restrictions.
Similarly, NPs increased hospice use rates by 2.88% in states with fewer restrictions and by only 1.77 in restricted practice states.
State policymakers may not have a proven reason behind the restrictions placed on some NPs, White told McKnight’s Long-Term Care News Friday.
“There is a robust body of evidence that NPs provide comparable care to physicians, and within nursing homes specifically, allow for expanded access to high-quality medical care,” she said. “There are no studies to my knowledge that have demonstrated that regulations that restrict NP scope of practice improve outcomes for patients.”
Regardless, NPs’ share of primary care visits for nursing home residents continues to tick up due to a shortage of qualified primary care physicians with expertise in senior care, White said. In fact, they already perform more than half of such visits.
