PBJ-derived turnover rates now factor into CMS Five-Star health inspection and quality measure scores, meaning facilities with rising turnover face quantifiable risk of citation increases and declining star ratings.
Health Care Staff Turnover and Quality of Care at Nursing Homes
In this cross-sectional study of 1.45 million facility-weeks (corresponding to 13,826 unique facilities), within a given facility periods of greater turnover of nursing staff were associated with lower quality of care along multiple measures according to health inspection citations and resident assessments. An additional 10 percentage points in nursing staff turnover in the 2 weeks before a health inspection was associated with an additional 0.241 citations in that inspection, compared with a mean of 5.98 citations.
Shen, Karen, Brian E. McGarry, and Ashvin D. Gandhi. “Health Care Staff Turnover and Quality of Care at Nursing Homes.” JAMA Internal Medicine, 09 October 2023. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2810616
Labor Unions and Staff Turnover in US Nursing Homes
We found that the presence of a union was associated with a 1.7 percentage point decrease in staff turnover (95% CI, −2.72 to −0.63 percentage points; P = .002). When more than 75% of nursing homes in a county were unionized, the facility-level presence of a union was associated with a 9.0 percentage point decrease in staff turnover (95% CI, −15.50 to −2.56 percentage points; P = .006).
Dean, Adam, et al .“Labor Unions and Staff Turnover in US Nursing Homes.” JAMA Network Open, vol. 6, no. 10, Oct. 2023, p. e2337898. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2810649
Nursing Home Staff Turnover and the Whole-of-Person Framework for Staff Retention
While Dean et al have added important evidence to the role of labor unionization to combat the US nursing home staff turnover crisis, it may be worth reviewing staff retention policies in a truly earnest fashion. What is it that makes a person stay? Exploring policies that promote a community approach to recruitment and retention and build an organic sense of belonging-in-place may be key for legislators and health care policy experts trying to solve the problem of US nursing home staff turnover.
Bergman, Christian. “Nursing Home Staff Turnover and the Whole-of-Person Framework for Staff Retention.” JAMA Network Open, vol. 6, no. 10, Oct. 2023, p. e2337827. https://doi.org/10.1001/jamanetworkopen.2023.37827.
Association Between Staff Turnover and Care Quality in Nursing Homes—Reply
We appreciate the Letter engaging with our study1 from Li et al. Their Letter suggests that future research should aim to encompass more measures of staffing, such as part-time and agency staffing. We agree that these dimensions of staffing, along with other dimensions, may be significantly associated with quality of care in nursing homes. Some of these associations are beginning to be assessed in the literature, including the role of agency staffing, daily variation in staffing stability, and overall staff size, which may capture some of the potential effects raised by Li et al.2-5 With the recent public availability of employee-level staffing data, we hope that future research will do more to disentangle and isolate the effects of the many variables.
— JAMA Network Open, January 29, 2024
LTC faces increased staffing churn, shrinking pool of relied-upon workers: study
The healthcare sector is experiencing increased worker turnover in the wake of the COVID-19 pandemic even as employment rates have steadied in many areas of the industry, according to a new JAMA Network study.
These results have especially worrying implications for the long-term care sector, according to lead author Karen Shen, PhD, assistant professor at Johns Hopkins University.
— McKnight’s Long-Term Care News, January 29, 2024
Nursing Home Staff Turnover and the Whole-of-Person Framework for Staff Retention
Staff turnover in US nursing homes was 53% in 2021, double that of hospitals. A critical review of staff retention policies is imperative. Labor unionization may be one way to address staff turnover, but in the broader framework of staff retention it may be important to consider a person-centered approach to job satisfaction.
— JAMA Network Open, October 13, 2023
Union representation is linked to a significant reduction in nursing home staff turnover, according to a first-of-its-kind research letter published Friday in JAMA Network Open. Among the 17.3% of nursing homes that were unionized in 2021, researchers found a 3.2% relative drop in turnover. In counties where more than 75% of nursing homes were unionized, the effect was a 17.1% reduction.
— McKnight’s Long-Term Care News, October 16, 2023
Unionization may decrease staffing turnover in nursing homes: study
According to a recent study published in the Journal of the American Medical Association, “labor unions representing nursing home workers, such as the Service Employees International Union (SEIU), argue that unions can decrease turnover by improving job quality, thus helping to maintain a stable workforce and improving resident care.” Unionization might be one way to reduce staffing turnover; however, in the broader framework of staff retention it may be important to consider a person-centered approach to job satisfaction.
— McKnight’s Senior Living, October 16, 2023
A first-of-its-kind research letter published in JAMA Network Open concludes that among unionized facilities, there’s a significant drop in staff turnover. In 2021, about 17.3% of nursing homes had union representation, and the researchers found a 3.2% relative decrease in turnover in these communities. In counties where more than 75% of nursing homes were union shops, the reduction in staff turnover was an impressive 17.1%.
— McKnight’s Long-Term Care News, October 16, 2023
Union Presence – Especially at a County Level – Associated with Lower Turnover at Nursing Homes
The presence of a union is associated with a 1.7 percentage point decrease in staff turnover, according to a study published on Friday in JAMA Network Open. This association was “significantly larger” when the county-level proportion of nursing homes that were unionized was high. Specifically, when more than 75% of nursing homes in a county were unionized, facility-level presence of a union was associated with a 9% decrease in staff turnover.
— Skilled Nursing News, October 13, 2023
Researchers say retention needs more attention as feds push to increase nursing home staffing levels
“The magnitude of … turnover effects are generally similar to the magnitude of the staffing level effects, suggesting that policies that monitor or reward facilities for lower staff turnover may be effective in improving quality of care,” Shen explained. “This study suggests we should be thinking about staffing consistency and retention just as much as overall staffing levels,” McGarry said.
— McKnight’s Long-Term Care News, October 09, 2023
High Staff Turnover in Nursing Homes Linked to Decreased Quality of Care
High staff turnover rates can disrupt the continuity of care, hinder the formation of vital staff-resident relationships, and limit the acquisition of skills and institutional knowledge through on-the-job experience. An additional 10 percentage points in nursing staff turnover in the two weeks before a health inspection were linked to an additional 0.241 citations in that inspection.
— Skilled Nursing News, October 09, 2023
