Study Suggests Nursing Homes Should Focus on Staff Retention

As the nursing home industry pushes back on the Biden administration’s proposal for mandatory federal staffing minimums, a new study suggests the U.S. may want to pivot away from recruitment and towards staffing retention in order to stabilize staffing rates.

Last month, Medicare proposed a new rule that would require long-term care facilities to have a registered nurse (RN) on site at all times and have staffing ratios of 0.55 RN hours per resident day and 2.45 nursing assistant hours per day. In a meeting last Thursday, the Medicare Payment Advisory Commission (MedPAC), which advises Congress on the Medicare program, suggested that the rule would exacerbate issues, STAT News reports. From Brian Miller, health policy researcher and assistant professor at Johns Hopkins University:

Recommending a staffing requirement that something like 80% of facilities cannot comply with is I think best described as policy insanity.

The MedPAC report also noted that freestanding nursing homes are not suffering from lack of funds with regards to its ongoing staffing crisis, operating in double-digit margins. From MedPAC Commissioner Lawrence Casalino, professor-emeritus at the Weill Cornell Medical School:

Something’s wrong here. If people are taking home 26% profits and they have high rates — maybe higher than 53% — of staff turnover, they’re not paying staff enough. They’re just taking the money for themselves.

A new JAMA Internal Medicine study published this week supports the argument that staff turnover in nursing homes is an industry-wide problem that could be a path to reducing the disparities in nursing home staff. The study analyzed 1.45 million facility-weeks for 13,826 facilities using data from the Centers for Medicare and Medicaid Services (CMS). It found that periods with higher turnover of nursing staff resulted in lower quality of care.

The study also found that the average annual turnover rate in nursing homes was as high as 128%. CMS began measuring and publishing turnover rates with the Nursing Home Compare tool in 2022. Skilled Nursing News notes that the high staff turnover rates were associated with a decrease in the quality of care provided to residents, especially with regard to patient functioning. A period of nurses leaving was linked to higher rates of citation and decreases in assessment-based quality measures.