This study examined the association between Nurse Practitioner (NP) and Physician Assistant (PA) staffing in nursing homes and the effect of a decision-aid regarding feeding options in dementia on the frequency of surrogate- provider discussions and on surrogates’ decisional conflict. We compared these outcomes for facilities that had no NP/PAs, part-time only NP/PA staffing, and full-time NP/PA staffing. The sample included 256 surrogate decision-makers from 24 nursing homes. The decision aid was associated with significant increases in discussion rates in facilities with part-time or no NP/PA staffing (26% v. 51%, p