To make it easier for families and caregivers to evaluate the quality of nursing homes, the Center for Medicare & Medicaid Services (CMS) regularly publishes data on its “Care Compare” website. Anyone can go to the site and search for a facility to find COVID updates, quarterly quality scores, and information on inspections, penalties, ownership, and more.
Last month, CMS added additional metrics to how it scores the quality of nursing homes. The information is now available for public consumption and will be factored into the facility quality scores given by CMS starting in July 2022.
· Staff Turnover
· Weekend Staffing Levels (nurse staff hours per resident per weekend day)
· Administrator Turnover
Staffing has become a nationwide issue that is impacting most industries, especially healthcare. Long-term care is getting hit particularly hard as over 400,000 providers have left since the beginning of the pandemic. That’s why it’s very important to understand the new measures, as they will impact your facility’s Star Rating and ultimately, the reimbursement seen from CMS. To help, we spent a little time doing some market research and analysis to share with the broader long-term care community.
With more nursing professionals seeking new ways to work and a deeper understanding of how things like COVID and weekend work preferences impact the ability to maintain proper staffing levels, one thing is abundantly clear – nursing homes will have to find ways beyond their full-time staff to maintain their standing with CMS.
Here’s what we found.
The Average Nationwide Turnover at Nursing Homes is ~52%
About half of all nursing homes have an average turnover between 40% and 60%. It’s important to note that turnover is not measured at the position level but at the person level. That means that if I owned a nursing home and had to refill a given position twice in a 12-month period, my turnover would be 66% (in all, I employed three nurses and two of them left).
Staffing Turnover Varies Greatly Across States
Generally speaking, nursing staff turnover is lower in the Northeast and higher in the South/Central U.S. Oklahoma’s average turnover of 61% is the highest in the country. While Hawaii boasts the lowest turnover nationally at 32%. California and Alaska also have relatively low turnover.
Average Nurse Turnover Correlates with State’s Average Quit Rates
As much as nursing homes struggle with staff retention, many other industries are also feeling the same pain. States with higher nursing staff turnover generally have higher quit rates across all industries as reported by the Bureau of Labor Statistics.
Why is this? It’s possible that nursing homes and other industries are similarly influenced by state-level economic factors like minimum-wage laws, labor-market conditions, and the availability of childcare.
Staffing Levels Matter
Understaffed facilities, characterized by a lower number of adjusted staffing hours per resident per day, tend to have higher turnover rates than facilities with better staffing ratios.
While it’s true that staffing levels play an important role in preventing burnout among nursing professionals, it’s also possible that higher turnover leads to less desirable staffing levels. Until now there was no way of quantifying this relationship. Now we know that turnover rates differ by about 10 percentage points between the lowest and highest quintiles of adjusted staffing hours per resident per day.
RNs Love Their Weekends
CMS has long reported staffing hours per resident per day. But now that we have staffing hours per resident per day on weekends, we can look at the difference between the all-week and weekend-only staffing measures for registered nurses to identify what we call our “Weekend Relaxation Score.” If a nursing home averages 5 RN staffing hours per resident for the entire week and 3 RN staffing hours per resident on weekends, they would have a Weekend Relaxation Score of 2 (5 less 3).
Based on this weekend relaxation score, the median RN turnover rate among the top and bottom quintile of nursing homes differ by a full 20 percentage points! That means that RNs stick around longer at facilities that give them a break on the weekends.
Facilities With New Ownership Have the Most Turnover
Just under 10% of nursing homes have changed ownership in the last year. These facilities with new ownership have a median turnover rate of 68%, about 17 percentage points higher than facilities without a change in ownership.
While this doesn’t prove that new ownership causes higher turnover, it is possible that higher turnover leads to a change in ownership.
About Half of Nursing Homes Have Had an Admin leave
Turnover isn’t only limited to nursing staff. CMS also reports how many administrators have left each nursing home in the past 12 months. Just about half of nursing homes experienced an administrator leaving in the reporting period. Some facilities (not shown in the chart for readability), have lost as many as 30 administrators.
5-Star Nursing Homes Are Better at Retaining Nurses
CMS communicates the quality of nursing homes through several star ratings associated with specific dimensions (staffing, health outcomes, etc.), as well as an overall star rating. As of Feb 2022, nursing staff turnover does not directly factor into star ratings, but will later this year.
1-star nursing homes have a median turnover of 60%, while 5-star nursing homes have a median turnover rate of around 45%. The average nurse will stick around for more than 6 months longer at a 5-star facility than a 1-star facility.
What About COVID?
Staffing turnover is lower at facilities with lower covid caseloads. Higher vaccination rates, better access to PPE, and other efforts to mitigate the spread of covid are associated with higher staff retention.
Some of this variation is likely captured by geography. States like Oklahoma and Missouri have the highest nurse turnover rates and relatively low vaccination rates. Hawaii, on the other hand, has the lowest turnover rate and a relatively high vaccination rate. But geographic patterns notwithstanding, it’s no secret that covid has taken a toll on the nursing community and we’d expect it to have some relationship to staff turnover rates.
How a Staffing Platform Can Help
The macro patterns behind staff turnover at nursing homes reveal an industry facing systemic challenges. Understaffed facilities, characterized by a lower number of adjusted staffing hours per resident per day, tend to have higher turnover rates than facilities with better staffing ratios. They are also more likely to have a lower STAR rating, which will eventually jeopardize their reimbursement from CMS. This will only exacerbate their staffing challenges. To break free of this unsustainable pattern, nursing homes need to leverage technology solutions and embrace new approaches to staffing. Now is the time for nursing homes to take a look at their staffing options – before it’s too late.
About Ben Tengelson
As Director of Data Science at IntelyCare, an AI-based nursing staffing platform that schedules and matches nursing professionals with open assignments at healthcare organizations nationwide. In his role at IntelyCare, Ben leads a brilliant team of data scientists and analysts in our mission to generate as much value as possible from IntelyCare’s data.