Dr. El

Late last week, the Centers for Medicare & Medicaid Services announced that they will begin to post staff turnover data on the Medicare.gov Care Compare website. 

In July, turnover will be incorporated into the Five Star Quality Rating calculations. 

While this is bound to cause immediate alarm among providers, in the long run this is a positive development for the industry.

Staff turnover is an excellent way to measure what’s going on inside a facility. If the staff is fleeing, there’s a problem. 

As the CMS memo on the subject put it, “lower turnover is associated with higher overall quality.” It offers several hypotheses why this might be so, including improved leadership by a consistent administrator, increased efficiency by staff familiar with policies and procedures, and the prevention of adverse outcomes through early recognition of changes in medical condition by staff who know their residents.

Attending to turnover has the potential to improve quality, reduce certain expenditures, and rehabilitate the public’s image of nursing homes. The asterisk on the title of this column, however, reflects the fact that the adjustment to this newly public data point is bound to be bumpy.

The reporting is starting in the middle of a pandemic that has had an outsized effect on residents and workers. The “problem” that employees are fleeing might be omicron as much as it is management and general working conditions. And the handling of COVID-19 has been dependent on numerous factors outside of facility control.

We can surmise that, initially, the published turnover rates will be astronomically high, such as those reported by Ashvin Gandhi, Huizi Yu, and David C. Grabowski in Health Affairs

The only good news, from an industry perspective, is that virtually everyone’s numbers are going to be abysmal, particularly in areas with widespread illness in the community. The consumer will have little choice but to select among homes with poor staff retention.

Going forward, however, facilities that distinguish themselves from their competitors will have an edge.  

Increasing wages and benefits has been recommended as a first step towards retaining staff. I’d also suggest attending to the emotional tenor of the nursing home. To swiftly stem the tide of departures of pandemic-weary staff, review and enhance the level of emotional support they’re being offered. 

Provide employee assistance programs (EAP), services, support groups, psychologist open office hours and other venues so that depleted staffers have places to refill the well and continue in their work.

Such supports will not only help employees overcome pandemic-related trauma but can also assist them in dealing with a host of problems usually unaddressed by long-term care employers, such as the loss of beloved residents, team conflicts, difficult families and dealings with residents who are challenging in a variety of ways. 

I’ve provided these services informally and gratis throughout my career. I’ve seen how they’ve improved staff retention and quality of care and I know how much more could be done if they were covered services provided on a regular basis.

I’ve been writing about turnover for a long time. See my 2014 piece, “The keys to reducing turnover in long-term care.” Or my 2018 post, “Dr. El’s ‘Quality of Life’ star ratings are the way to go,” in which I proposed a supplemental five-star rating system, with the first star measuring staff turnover. 

Now that turnover is being added to Nursing Home Compare, I’m feeling more optimistic. 

I started my biweekly McKnight’s column on LTC mental health issues in March 2013 with, “Inside the mind of an LTC shrink.” Surely it can’t be long now before someone at CMS recognizes that expanding mental health training and support for staff will improve care quality. 

Of course, it would help the cause to have a study of the subject by David Grabowski, Ashvin Gandhi or another of the many illustrious healthcare researchers who are investigating our oft-disregarded field. 

Until then, partner with a university psychology department, use your own pre- and post-intervention measures, or take my word for it: attending to the emotional tenor of the nursing home will reduce turnover and increase care quality.

Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is a Bronze Medalist for Best Blog in the American Society of Business Publication Editors national competition andGold Medalist in the Blog-How To/Tips/Service category in their Midwest Regional competition. To contact her for speaking engagements, visit her at EleanorFeldmanBarbera.com.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.