Nursing Home Staff Turnover Increases Health and Safety Risks for Residents: Study

Research has long shown that low staffing in nursing homes reduces the quality of care provided to residents, but the findings of a new study indicate that frequent staffing turnover also has an impact, and may increase the risk of nursing home neglect injuries.

During an average week, roughly 15% of staff members working in nursing home facilities are new employees still learning about their new patients, their jobs, and the facility, according to a group of U.S. researchers. However, some facilities have turnover rates as high as 125%, which can have an outsized impact on the quality of care.

In a report published on October 9 in the journal JAMA Internal Medicine, researchers from Johns Hopkins Bloomberg School of Public Health, the University of California, Los Angeles (UCLA); and the University of Rochester, New York, conducted a cross-sectional study evaluating data from nearly 14,000 nursing home facilities to confirm the impact of nursing home staff turnover.

Researchers used data from the U.S. Centers for Medicare & Medicaid Services on health inspection citations and quality measures at U.S. nursing homes. The researchers then combined the data with turnover information derived from daily staffing payroll data from 2017 to 2019. The data covered 1.06 billion shifts for more than 7.48 million employees at 15,869 facilities.

According to the findings, during an average week 15% of nursing home staff and nearly 12% of nursing home administrators were new hires.

Each facility had roughly an average of six citations for issues involving the quality of nursing home care provided. However, if turnover at a nursing home was 10% higher than normal in the two weeks before an inspection, researchers found that the nursing home saw a 4% increased risk of receiving a citation for nursing home neglect and other deficiencies.

A 10% increase in nursing staff turnover was also linked to a decrease in quality measures for patients and reduced patient functioning, the data indicates.

Nursing Home Staffing Turnover Risks

Prior research has linked nursing home staffing shortages to reduced quality of care and increased COVID-19 deaths during the pandemic.

Additionally, staffing shortages make it harder for hospitals to discharge elderly patients back to nursing homes and receive new admissions because the nursing homes are short-staffed and unable to care for the existing patients, previous researcher has indicated.

But the findings of the new study indicate staffing turnover rates, not just shortages, also lead to reduced care among patients. Periods of high turnover of nursing staff are linked to lower quality of care along multiple measures, according to health inspection citations and resident assessments.

Turnover disrupts patient care and leads to operational difficulties, including missed or late medications and less frequent check-ins, the researchers determined.

The White House recently announced plans to impose new mandatory requirements for nursing home staffing hours. But these latest findings indicate staffing hours and nursing home staff turnover are both critical factors for patient quality care.

“Within-facility variation in staff turnover was associated with decreased quality of care,” the researchers concluded. “These findings suggest that efforts to monitor and reduce staff turnover may be able to improve patient outcomes.”