Is nursing home staff turnover a good quality metric?

There are a few sub-questions we need to break down to answer before answering this one larger question. These sub-questions include:

1. Is nursing staff turnover at nursing homes a big problem?
2. Is nursing staff turnover correlated with quality of care?
3. Does using nursing staff turnover as a quality metric provide the right incentives?

A paper by Ghandi, Yu and Grabowski (2021) provide some answers to these questions. To do so, they look at employee-level data between October 1,2016, and March 31, 2019 from the Payroll Based Journal; while CMS’s data.cms.gov has aggregated daily counts of staffing hours, the Ghandi paper’s use of individual employee data allows for a weighted measure of employee turnover based on hours worked. Thus, their turnover metrics weights turnover by a full-time worker more heavily than a part-time worker.