Solving the Nursing Home Turnover Crisis

Ideas and Issues

nurse turnover, nursing home crisis, healthcare, certified nursing assistant

March 3, 2021

New Orleans      Nursing homes have been a flashpoint during the pandemic as death rates for residents and staff have been tragic and appalling. The situation was seen as so critical that vaccines were prioritized for the homes, where now the struggle is getting sufficient staff to participate, even as families have pushed for loved ones to get protection so that they can return to visit and assist in care. Families and the elderly themselves are increasingly resistant to moving into nursing homes as the pandemic continues, yet the demand for reforms have not been as loud and strident as the situation would seem to demand.

A recent study by academics at UCLA and Harvard received some deserved attention by looking at the impact of turnover of nursing staff in the homes as perhaps an underlying part of the crisis. The topline of the story was that after examining the payroll data from the Center for Medicaid and Medicare Services (CMS) the average turnover was 128% in the more than 15,600 homes for which data was available. This current turnover more than doubles previous studies.

The report was graciously shared with Local 100 United Labor Unions by its lead author, Professor Ashvin Gandhi, and its conclusions, from a union perspective, are almost an “I told you so” moment from countless years of recurring bargaining sessions with employers at the homes that we represent. Inadequate wages and benefits were felt to be a major trigger for the turnover. Certified nursing assistants (CNAs) on the firing line experienced universally high turnover rates, and provide the bulk of nursing home staffing, despite usually poor wages and benefits.

The authors found three patterns emerging from the data on turnover:

  • There was a direct correlation between turnover and regions with lower per capita income indicating “inadequate pay.”
  • Turnover tended to be higher in for-profit homes and within nursing home chains where support for staff was a lower priority.
  • A higher Medicaid census of clients because of its lower reimbursement rates meant a reduced capacity to provide adequate pay and benefits.

Looking at the geography of turnover was disturbing as well. States like Texas and Oklahoma drug the bottom with turnover rates between 118 and 165% annually. Arkansas and Louisiana, where we represent nursing home workers, ranged between 98 and 118%. The lack of job alternatives may account for the relatively better turnover in Mississippi, Alabama, and Georgia in the 39 to 73% range. The best states were California, Alaska, Wisconsin, New York, New Jersey, and Connecticut. I might add that unionization rates are somewhat better in some of those states as are nonprofit concentrations.

The authors weren’t singing “Solidarity Forever,” but their recommendations for reform would fit nicely in union contracts and lobbying campaigns. They suggested that the feds and states earmark increased reimbursement to improved wages and benefits. They also felt including nursing workers in health insurance programs and not penalizing them for sick leave would make a huge difference. Amen!

In the stages of mourning for nursing home deaths, now should be time to demand change at every level.