Study Reveals Nursing Home Understaffing Problems and High Turnover Rates Impacted Quality of Care Before Pandemic

After the COVID-19 pandemic emerged last year, many nursing homes and long-term care facilities were hit particularly hard, raising concerns about whether facilities had adequate staffing and precautions in place to prevent the rapid spread of infection. However, new research indicates turnover and understaffing at nursing homes has been an issue for years.

In findings published this month in the journal Health Affairs, researchers highlight the long-standing understaffing problems at nursing homes and long term care facilities nationwide, indicating some facilities have turnover rates as high as 300%.

A team of researchers with the University of California Los Angeles Anderson School of Management reviewed Centers for Medicare and Medicaid Services (CMS) data involving 492 million nurse shifts collected since July 2016, to calculate a turnover metric at the 15,645 nursing home and long term care facilities across the U.S.

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The mean and median annual turnover rates for nursing home staff was found to be 128% and 94%, respectively, with some facilities reaching as high as 300% turnover. The extraordinarily high turnover rate at nursing homes posed a crisis prior to the pandemic, according to the researchers.

Throughout the COVID-19 pandemic, an estimated 216,219 cases have been confirmed in nursing homes, which have resulted at least 54,000 deaths among residents and staff, with nursing home coronavirus outbreaks often striking the worst performing facilities according to CMS ratings.

A report released in January by New York Attorney General Letitia James, highlighted a number of failures by long-term care facilities and state regulators, which contributed to the high number of COVID-19 deaths at nursing homes in the state last year. Specifically, the report indicated New York nursing homes with lower pre-pandemic staffing ratings had a higher number of fatalities during the pandemic, when compared to facilities with sufficient pre-pandemic staffing rates.

CMS publicly releases rating data for facilities nationwide on its Nursing Home Compare website, which presents data from health inspections, staffing and other quality of care measures.

“Nursing staff turnover has long been considered an important indicator of nursing home quality. However, turnover has never been reported on the Nursing Home Compare website, likely because of the lack of adequate data,” the researchers noted. “Disseminating facilities’ nursing staff turnover rates on Nursing Home Compare could provide important information for policy makers, payers and consumers, and it may incentivize efforts to reduce turnover.”

In September 2020, the U.S. Centers for Disease Control and Preventions (CDC) Morbidity and Mortality Weekly Report identified a correlation between how well a nursing home was rated by CMS, and whether the facility was able to prevent or control COVID-19 outbreaks during the on-going pandemic.

The report found facilities with a 1-star rating were 87% more likely to experience a COVID-19 outbreak when compared to a facility with a 2 to 3 star rating and 94% more likely when compared to those with a 4 to 5 star rating.

Federal investigators continue to explore the possibility of nursing home neglect playing a role in the COVID-19 outbreak, which was first detected in a nursing home in Washington State that became the epicenter for the U.S. pandemic. Investigators say the nursing home failed to respond to the outbreak adequately, placing residents in jeopardy of illness and death.


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