Association between staff turnover and nursing home quality – evidence from payroll-based journal data

Published: May 7, 2022
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PBJ Central Notes: This study is of particular interest as it was funded by a grant from CMS.  Authors include Evan Shulman, currently Director of the Nursing Homes division at CMS and three employees of ABT Associates, a CMS contractor working on the Five Star Quality Rating System since 2008

Staff turnover is considered an important indicator of nursing home quality. We used auditable staffing data from the Centers for Medicare & Medicaid Services (CMS) Payroll-Based Journal (PBJ) system to calculate turnover measures for nurse staff and administrators and examined the relationship between turnover and nursing home quality.

Mean annual turnover rates were about 44% for RNs and 46% for total nurse staff. On average, there was one administrator leaving each nursing home during this period although about half of nursing homes had no administrator turnover.

Turnover rates varied greatly across nursing homes. For-profit and larger nursing homes had higher turnover rates. Higher turnover was consistently associated with lower quality of care.

Our study highlights the importance of staff turnover due to its relationship to nursing home quality. In January 2022, CMS started posting turnover measures on Care Compare to allow consumers to use this information in their assessment of nursing home quality and to motivate nursing homes to implement innovative strategies to retain staff. While these actions are challenging, they are nonetheless warranted for improving the quality of care for nursing home residents.

Zheng, Qing, et al. “Association between Staff Turnover and Nursing Home Quality – Evidence from Payroll‐based Journal Data.Journal of the American Geriatrics Society, 2022. Crossref,