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Health Care Worker Violence and Impacts on Health of Institutionalized ADRD Patients

Award Number: R01AG100925
ORGANIZATION: NATIONAL INSTITUTE ON AGING
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/01/2026
PERIOD OF PERFORMANCE END DATE: 05/31/2031

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Health Care Worker Violence and Impacts on Health of Institutionalized ADRD Patients - Project Summary 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.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $809,762 )
2026	2026	THE RAND CORPORATION	1776 MAIN ST	SANTA MONICA	CA	90401	LOS ANGELES	USA	Aging Research	000	1	8/11/2026	NEW	$809,762
														Subtotal = $809,762

Grand Total All Awards = $809,762

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Health Care Worker Violence and Impacts on Health of Institutionalized ADRD Patients

Award Number: R01AG100925

ORGANIZATION: NATIONAL INSTITUTE ON AGING

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 09/01/2026

PERIOD OF PERFORMANCE END DATE: 05/31/2031

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