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

A new study highlights the persistent problems caused by an unstable work force, an underlying threat that may have led to staggering death tolls in the pandemic.

Extraordinarily high turnover among staffs at nursing homes likely contributed to the shocking number of deaths at the facilities during the pandemic, the authors of a new study suggested.

The study, which was published Monday in Health Affairs, a health policy journal, represents a comprehensive look at the turnover rates in 15,645 nursing homes across the country, accounting for nearly all of the facilities certified by the federal government. The researchers found the average annual rate was 128 percent, with some facilities experiencing turnover that exceeded 300 percent.

“It was really staggering,” said David Grabowski, a professor of health care policy at Harvard Medical School and one of the study’s authors. Researchers pointed to the findings to urge Medicare to publish the turnover rates at individual nursing home sites, as a way of putting a spotlight on substandard conditions and pressuring owners to make improvements.

Inadequate staffing — and low pay — has long plagued nursing homes and quality-of-care for the more than one million residents who live in these facilities. But the pandemic has exposed these issues even more sharply, with investigations underway into some states’ oversight of the facilities as Covid cases spiraled unchecked and deaths skyrocketed.

The high turnover rate likely made it harder for nursing homes to put in place strong infection controls during the pandemic, and led to rampant spread of the coronavirus, said Ashvin Gandhi, the lead author and a health economist and assistant professor at the University of California Los Angeles Anderson School of Management.

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