A nurse helps a resident stand up
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Nursing home providers should consider implementing innovative strategies for retaining workers after a new study found that low staff turnover was consistently associated with higher quality of care, researchers said. 

“While these actions are challenging — especially given that nursing homes are navigating the COVID-19 pandemic, they are clearly warranted if we seek an improved quality of care for nursing home residents,” Qing Zheng, Ph.D.,  lead author and health economist at research firm Abt Associates, told McKnight’s Long-Term Care News on Monday.  

The findings were published Saturday in the Journal of the American Geriatrics Society. Study authors also include Evan Schulman, director of the Division of Nursing Homes for the Centers for Medicare & Medicaid Services; Christianna S. Williams Ph.D. and Alan J. White, Ph.D., who both work for Abt Associates, a federal contractor. The study was funded by CMS under a research contract.

Investigators used Payroll-Based Journal data for more than 13,600 nursing homes from October 2018 through September 2019 to compare staff turnover measures to nursing home quality measures and star ratings. 

Overall, they found that the average annual staff turnover rates were about 44% for registered nurses and 46% for total nursing staff. The annual turnover rates for both groups were lower among nursing homes with higher star ratings. 

Researchers said the pattern was consistent across levels of star ratings. They found that average total nursing staff annual turnover rates were 53.4% among 1-star nursing homes, while it was 40.7% for 5-star facilities. 

They also found nursing staff turnover rates were lower among nonprofit, smaller, hospital-based, and rural nursing homes. Data also showed a consistent relationship between higher turnover and lower probability of having higher star ratings across all domains.  

“Compared to facilities with low total nurse staff turnover rates, nursing homes with high total nurse staff turnover rates were 16 percentage points more likely to have one-star rating, 10.5 percentage points more likely to have two stars, but 20.3 percentage points less likely to have five stars, after adjusting for other factors that may affect their star ratings,” researchers wrote

They said their findings confirm an association between staffing levels and quality, and shed new light on the importance of staff consistency. 

“Publicly reporting these turnover measures for nursing homes motivates nursing homes to focus on staff retention and reducing turnover,” Zheng told McKnight’s

“Providers should monitor and analyze these data and their turnover measures over time. As our study shows, higher turnover measures are consistently associated with lower quality of care,” Zheng added. “Giving these findings, providers should consider implementing innovative strategies to retain staff and reduce turnover, which ultimately will lead to improvement in quality of care for nursing home residents.”