Reducing Staff Turnover in Nursing Homes
High staff turnover in nursing homes has been a long-standing concern for policymakers and industry stakeholders. New data suggests that the average nursing facility will replace more than half its direct care staff every year. Historic staffing shortages brought on by the COVID-19 pandemic have only exacerbated this nationwide workforce crisis.
With fewer available staff, nursing homes nationwide are struggling to adequately care for residents, with studies linking insufficient staffing levels to decreased quality of care, poorer health outcomes, and higher instances of resident abuse. Similarly, short-staffed facilities are more likely to perform poorer on all Centers for Medicare & Medicaid Services Five-Star Quality Ratings, which directly measure the facility's capacity to provide safe, quality care to residents.
Today, there is a resounding call for change among staff, industry leaders, and government officials. Not only to improve nursing home safety and care quality but also to address poor job quality and working conditions for care teams in more than 15,000 nursing homes nationwide.
In this guide, we’ll examine the root causes of high staff turnover in nursing homes and its impact on residents and staff. We’ll close with actionable recommendations for reducing staff turnover in nursing homes by leveraging practical and innovative solutions to tackle this urgent problem.
Why is Staff Turnover Higher in Nursing Homes?
Among healthcare industry workers, nursing home staff are twice as likely to leave their jobs than nursing staff in other care settings. Numerous studies link this heightened turnover rate to several factors, including gaps in wages and benefits, limited training resources, challenging working conditions, and unclear pathways for career advancement. These factors combined contribute to a challenging environment that impacts the quality of care provided to residents and jeopardizes nursing home staff's well-being and job satisfaction.
Wage and Benefit Concerns
Nursing home staff have historically been disadvantaged in nearly every aspect of total compensation, including wages, benefits, and paid leave. According to the Bureau of Labor Statistics, registered nurses (RNs) working in nursing homes make 7% less than RNs working in hospitals. Of the 447,000 certified nursing assistants (CNAs) working in nursing homes, more than 40% rely on public assistance, with 12% living in a household below the federal poverty line. A study published in 2020 also found that more than 60% of nursing home staff did not have paid leave. These discrepancies in compensation are one of the top reasons why care workers leave their positions in nursing homes for more financially rewarding roles.
Wage and Benefit Concerns
Comprehensive staff training is central to ensuring resident safety and overall job satisfaction. However, in many nursing homes, robust training programs are often limited due to various organizational challenges, such as limited budgets for training programs, staffing shortages, and time constraints. Consequently, this may leave employees feeling underprepared to handle the demands of their roles. As a result, staff are more likely to report increased stress and job dissatisfaction.
Challenging Working Conditions
Working conditions in nursing homes significantly impact staff turnover rates. Heavy workloads, insufficient staffing levels, and limited resources contribute to increased stress and burnout among care workers. This situation is further complicated by a massive exit of the Baby Boomer generation (i.e., adults 60+) from long-term care work, creating a significant workforce gap that has proven difficult to fill. Despite calls for a minimum federal floor for safe staffing levels, most nursing homes in the U.S. struggle to fill vacant roles and prevent burnout among staff.
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Unclear Pathways for Career AdvancementResearch indicates that career development opportunities are critical to job satisfaction and staff retention among healthcare workers. However, in many nursing homes, career progression pathways are not widely used or well-developed. This lack of growth opportunities for staff, especially those seeking postsecondary credentials, is a primary driver of staff dissatisfaction and turnover in nursing homes.
How Staff Turnover Impacts Nursing Home Residents and Staff
High staff turnover in nursing homes has significant repercussions for both residents and staff. Most importantly, high turnover rates cause disruptions in care continuity and quality. On an average week, 15% of nursing staff are new hires due to staff turnover. For residents, this means that they often encounter unfamiliar faces providing their care, resulting in inconsistency and potential gaps in the delivery of personalized care plans.
In some cases, the consequences of staff turnover are more severe. CMS findings report that nursing homes with a turnover rate of 50% or greater have a 1.5 times higher rate of resident abuse. When nursing home staff are stretched too thin, residents are more likely to go without basic necessities and suffer from avoidable injuries due to falls, neglect, and lapses in supervision.
Beyond the immediate safety implications, staff turnover takes a significant emotional toll on care workers as they struggle to deliver consistent and compassionate care amidst the constant churn of staff and administrators.
The Link Between High Staff Turnover and Lower 5-Star Quality Ratings
High staff turnover rates jeopardize resident safety and significantly impact a nursing home's quality ratings, as assessed by the Centers for Medicare and Medicaid Services (CMS). The CMS Five-Star Quality Rating System evaluates facilities based on three domains: Health Inspections, Quality Measures, and Staffing.
Historical trends indicate a direct correlation between low-rated facilities and turnover rates, with the lowest-rated facilities experiencing the highest median turnover rate. Researchers have cited this same relationship between turnover and all three CMS domains. Simply put, turnover and short staffing increase the likelihood of deficiencies in care, avoidable accidents, and an overall decreased quality of care.
Consequently, these lower ratings negatively affect a facility's reputation, enrollments, and government funding. The correlation between staff turnover and quality ratings underscores the importance of addressing turnover rates to enhance both resident safety and overall nursing home quality.
Solutions to Reduce Staff Turnover in Nursing Homes
Nursing home staff find themselves caught in a repetitive cycle. Staff shortages require the remaining staff to shoulder heavier workloads, resulting in burnout and compromised quality of care. When staff inevitably leave, the organization and remaining staff pay the price. The costs of staff turnover strain an already resource-limited facility, making it difficult to allocate adequate funds to higher wages, benefits, and training for staff.
While this situation is challenging, there are simple and effective solutions that nursing homes can implement to stop this cycle and reduce staff turnover.
Limitations
While improving wages and incentives helps motivate employees to stay at their jobs longer, it does pose challenges for facilities with limited financial resources. Many nursing homes rely heavily on Medicaid reimbursements, which may not always be sufficient to cover the costs of higher wages and benefits. Despite efforts by some states to introduce wage pass-through policies, allocating these funds toward staff compensation has proven difficult due to competing financial demands within these organizations.
Increasing staff wages is widely recognized as an effective staff retention strategy. Studies consistently show a direct link between higher wages and lower staff turnover. While direct wage increases are not a short-term fix, prioritizing competitive wages and benefits is essential to attracting and retaining qualified staff. In addition to offering wage increases, facilities can explore alternative incentives to boost staff morale and make the workplace more attractive without significantly impacting their bottom line. These incentives can include providing meals or food to employees, offering more flexible scheduling, or offering one-time signing bonuses.
Offer Additional Training and Growth Opportunities
Studies indicate that offering upskilling opportunities is a straightforward solution to keeping staff motivated, satisfied, and retained. Additionally, investing in training and upskilling opportunities has a range of benefits for facilities and patients. A more highly trained staff is better equipped to provide higher quality care and adapt to complex patient needs, ultimately leading to improved patient outcomes and satisfaction.
The National Academies of Sciences, Engineering, and Medicine (NASEM) recommends that state and federal governments provide all nursing staff free access to entry-level and continuing education training programs. If implemented, this initiative could offset the financial costs of training programs and positively impact growth opportunities for nursing home staff. Mentorship programs are another cost-effective opportunity to bolster staff training and development. By pairing experienced staff with newer employees, facilities can create a supportive learning environment where knowledge and skills are transferred organically.
Limitations
While offering additional training and growth opportunities is beneficial, there are several limitations. Cost is the most notable barrier. Without financial support from state and federal governments, it is challenging for nursing homes to facilitate and fund staff training programs.
Additionally, time constraints can significantly hinder staff participation in these programs. Nursing home staff have demanding work schedules, leaving limited time for additional training outside of their regular duties. Similarly, while mentoring programs offer valuable opportunities for skill development and knowledge transfer, their effectiveness may be limited by mentor availability and the time required to establish meaningful mentor-mentee relationships. Together, these factors can hinder the effectiveness of these retention solutions.
Utilize Technology-Based Solutions
While systemic changes like wage increases and training programs are critical for addressing long-term staffing challenges, it is clear that smaller, more practical solutions are needed to reduce staff turnover in nursing homes.
As mentioned above, one of the top reasons for staff turnover in nursing homes is the challenging working conditions. When nursing teams are understaffed and overworked, there is a higher likelihood of avoidable accidents like falls or medication errors. An increase in these preventable accidents can lead to heavier workloads and increased stress as staff handle the repercussions of these incidents.
Fortunately, technology-based solutions, like remote patient monitoring (RPM) devices, can help reduce workloads and alleviate the mental and physical strain that nursing staff often experience. Most importantly, these innovative solutions can improve resident safety and health outcomes by enhancing efficiencies in care delivery.
For example, with remote patient monitoring, nursing staff can continuously monitor a resident’s vital signs and activities without being physically present. Real-time alerts from these devices can also help nurses promptly respond to emergencies and mitigate potential risks like a dementia patient wandering from their room at night. This, in turn, allows caregivers to focus on providing more consistent, personalized care without the constant worry or stress.
Today, several effective technology-based solutions can help improve working conditions and resident safety in nursing homes, including bed alarms, automated medication dispensers, fall detection devices, and video monitoring systems. In 2021, our team introduced a novel fall prevention solution that has the potential to revolutionize the way nursing staff approach and manage resident safety.
Introducing OK2StandUP: Preventing Falls and Improving Working Conditions in Long-Term Care
OK2StandUP is the first-of-its-kind AI-driven fall prevention solution designed to proactively detect and mitigate fall risks among nursing home residents. This discreet, wearable device takes fall detection one step further by utilizing advanced algorithms and real-time monitoring to predict and prevent falls before they occur.
By implementing OK2StandUP, nursing homes can significantly enhance resident safety and well-being while improving staff working conditions. The AI-powered device provides much-needed staff support, lessening the stress and workload of delivering care by reducing fall rates and creating a more positive and predictable work environment for staff.
How It Works
- Measure: OK2StandUP monitors an adult’s physical movements 24/7 via a device on the wearer’s chest and transmits data to a smartphone app.
- Predict: the system uses AI to analyze the patient's movements and activities, predicting with high accuracy (95%) when a wearer intends to get up and go.
- Act: Once detected, caregivers receive an alert via the smartphone app, allowing them to intervene and provide assistance when needed.
OK2StandUP’s powerful AI technology provides nursing home staff with valuable information on residents’ activities and potential risks, eliminating the guesswork and streamlining decision-making processes. With only two components – the device and the mobile app – OK2StandUP is easy to implement and use, allowing nursing staff to seamlessly incorporate this tool into their existing workflows and routines.
In recent trials conducted across five care organizations, OK2StandUP showcased its effectiveness in preventing falls and reducing workloads and stress levels among staff. After 4,500 hours of remote patient monitoring of 44 frail seniors, OK2StandUP helped reduce falls by 95% with AI-driven RPM and real-time interventions. For firsthand accounts of OK2StandUP’s impact, watch our video featuring testimonials from PSCN caregivers and administrators.
To experience the transformative impact OK2StandUP can have on resident safety and staff well-being in your care communities, sign up for a free 30-day trial today.
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