Ken Moon is an Associate Professor of Operations, Technology and Information Management at the SC Cornell Johnson College of Business and a Senior Fellow of Operations, Information and Decisions at the Wharton School, University of Pennsylvania. Jong Myeong Lim is an Assistant Professor of Management Science and Health Management and Policy at Miami Herbert Business School, University of Miami. Minje Park is an Assistant Professor at the HKU Business School, University of Hong Kong.
Imagine putting your loved relatives in a nursing home, hoping they’ll get the care and attention they deserve, only to learn that some facilities may use powerful drugs to keep residents quiet, not because they need them, but because there aren’t enough staff to help. It sounds shocking. But that’s exactly what our new research study suggests: when nursing homes lack sufficient staff, they’re more likely to use antipsychotic medications to sedate residents.
Nursing Home Staffing Crisis
U.S. nursing homes have been trapped in a staffing crisis in the past two decades. Low wages, high turnover, and profit-driven management have left facilities across the country struggling to maintain adequate care. During the COVID-19 pandemic, the situation became even more dire: nearly all nursing homes reported being short-staffed, with many so overwhelmed they had to restrict new admissions.
We know that short-staffing often results in lower quality care (e.g., inadequate monitoring, delayed assistance, or inadequate hygiene). Our study goes further, uncovering a disturbing consequence that has flown under the radar: nursing home understaffing may not just harm patient care—it may lead to a hidden form of abuse.
The Hidden Use of Antipsychotics as Chemical Restraints
Caring for seniors with dementia is challenging. They can wander, get confused, and even act aggressively. With enough staff, these behaviors can be managed safely with patience and compassion. Yet when facilities are understaffed, there’s a troubling shortcut: using antipsychotic drugs to sedate patients.
These drugs are designed to treat serious mental illnesses like schizophrenia, not to manage dementia or to safely sedate patients. In fact, using them for elderly patients with dementia can be dangerous, even deadly, as the FDA warns. Yet, in some nursing homes, this practice has become disturbingly common.
What Our Research Finds
To get a clear picture, we went straight to the source. We filed a Freedom of Information Act (FOIA) request to access internal data from the Centers for Medicare & Medicaid Services (CMS), which tracks how much antipsychotics nursing homes are actually using, without any exclusions. According to these data, 20% of nursing home residents, on average, are given antipsychotics.
Then, we examine a simple question: Do staffing levels directly affect antipsychotic drug use in nursing homes? Our answer, drawn from multiple statistical analyses, is yes.
We found that when nurse staffing increases by 15 minutes per resident per day, the number of residents being given antipsychotic drugs drops significantly, by about 1.5 fewer residents per facility. The incentive to sedate rather than care for patients appears to be particularly strong in urban and for-profit nursing homes, for whom the competitive pressure to cut costs is most acute.
We estimate that stricter federal staffing rules proposed by CMS in 2024 could have led to 24,000 fewer nursing home residents being medicated with antipsychotics—a nearly 10% drop. Recently, however, these new rules were struck down by a Texas federal court in April 2025, leaving the future of staffing reform in uncertain limbo.
What sets our study apart is that we go beyond correlation: that is, we use two separate but equally rigorous methods to show a causal relationship between staffing levels and antipsychotic use in nursing homes. In short, lower staffing doesn’t just occur alongside heavier use of medication; one actually causes the other to increase.
Why This Matters
Our research reveals more than just troubling statistics: it highlights serious ethical concerns. Relying on powerful drugs to quiet someone because there aren’t enough caregivers isn’t just a shortcut, but it crosses a moral line. We also show that understaffing doesn’t just lead to slower service or missed medications. It can push facilities toward unethical actions, especially when patients can’t speak up or advocate for themselves.
For families, it’s a reminder to ask hard questions when choosing a facility: How many staff are on duty? How are residents with dementia cared for? And what medications are being used, and why? At the heart of our research is a simple truth: More caregivers mean fewer drugs—and better, safer care for our loved ones.
Views of our Guest Bloggers are theirs alone, and not of the Pension Research Council, the Wharton School, or the University of Pennsylvania.
