Training Nonnursing Staff to Assist with Nutritional Care Delivery in Nursing Homes: A Cost-Effectiveness Analysis

Sandra F. Simmons, Emily K. Hollingsworth, Emily A. Long, Xulei Liu, Matthew S. Shotwell, Emmett Keeler, Ruopeng An, Heidi J. Silver

Research output: Contribution to journalArticlepeer-review


Objectives: To determine the effect and cost-effectiveness of training nonnursing staff to provide feeding assistance for nutritionally at-risk nursing home (NH) residents. Design: Randomized, controlled trial. Setting: Five community NHs. Participants: Long-stay NH residents with an order for caloric supplementation (N = 122). Intervention: Research staff provided an 8-hour training curriculum to nonnursing staff. Trained staff were assigned to between-meal supplement or snack delivery for the intervention group; the control group received usual care. Measurements: Research staff used standardized observations and weighed-intake methods to measure frequency of between-meal delivery, staff assistance time, and resident caloric intake. Results: Fifty staff (mean 10 per site) completed training. The intervention had a significant effect on between-meal caloric intake (F = 56.29, P <.001), with the intervention group consuming, on average, 163.33 (95% CI = 120.19–206.47) calories per person per day more than the usual care control group. The intervention costs were $1.27 per person per day higher than usual care (P <.001). The incremental cost-effectiveness ratio for the intervention was 134 kcal per dollar. The increase in cost was due to the higher frequency and number of snack items given per person per day and the associated staff time to provide assistance. Conclusion: It is cost effective to train nonnursing staff to provide caloric supplementation, and this practice has a positive effect on residents’ between-meal intake.

Original languageEnglish (US)
Pages (from-to)313-322
Number of pages10
JournalJournal of the American Geriatrics Society
Issue number2
StatePublished - Feb 1 2017


  • feeding assistant regulation
  • long-term care
  • staff training
  • unintentional weight loss

ASJC Scopus subject areas

  • Geriatrics and Gerontology


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