High Staff Turnover at U.S. Nursing Homes Poses Risks for Residents’ Care

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

That’s the title of a New York Times piece initially posted March 1, 2021 and updated on March 5, 2021.  For veterans of the nursing home industry (that includes me), this is not “new” news, but it does bear far deeper consideration, especially during the past year plus of battling the coronavirus throughout the world and in particular our LTC facilities.  It certainly caught my eye.

The NYT’s piece references a study published in a Health Affairs journal in early March.  The study was conducted by Ashvin Gandhi, Huizi Yu and David C. Grabowski.  These researchers studied PBJ (Payroll Based Journal) data, specifically “492 million nurse shifts from these data to calculate a novel turnover metric representing the percentage of hours of nursing staff care that turned over annually at each of 15,645 facilities.  Mean and median annual turnover rates for total nursing staff were roughly 128 percent and 94 percent, respectively. Turnover rates were correlated with facility location, for-profit status, chain ownership, Medicaid patient census, and star ratings.”   These turnover rates were tied to PBJ data in 2017 and 2018 – prior to the current pandemic.

In case you missed the jaw-dropper in the excerpt I pulled out from the abstract above … Mean and median annual turnover rates for total nursing staff were roughly 128% and 94% respectively.  The NYT’s article added this statistic: “the researchers found the average annual rate was 128 percent, with some facilities experiencing turnover that exceeded 300 percent.”  (Remember the data studied was from 2017 and 2018 – a full 2 to 3 years before the pandemic.)

Here are some additional statistics found in the NYT’s article:

  • Registered nurses, who are the most skilled workers, had the highest rates of turnover, and turnover varied widely across facilities.
  • Among the states with the highest rates were Oklahoma, Montana and Kansas.
  • Facilities that had low-star ratings on Medicare’s website comparing nursing homes had the highest median turnover, and nursing homes with high ratings had the lowest turnover.
  • Turnover was also higher at for-profit institutions, owned by chains and those serving Medicaid beneficiaries.

“At least 172,000 deaths from the virus had been reported among either residents or employees of nursing homes and other long-term care facilities by late February, according to a database compiled by The New York Times. The nursing home death toll alone has accounted for more than one-third of all Covid deaths in the United States, although death and case rates have begun to decline steeply as more than 70 percent of residents have received vaccinations.”

Food for thought?  Indeed.  Is now the time to address LTC turnover and take steps to reduce it?  A resounding YES from this LTC veteran.  Please read the article and take stock of your facility’s turnover rates.  No time like the present.  You know that legislators are no doubt looking at this very issue and it will be addressed at some point – it needs to be.   The study researchers made these suggestions/recommendations at the national level:

  • Medicare could incorporate turnover into its star-rating system.
  • Medicare and Medicaid could reward nursing homes with higher rates if they had lower turnover.

What can you do at the local level in your community – at your facility??  Involve your staff in the solution(s).