High Turnover at Nursing Homes Threatens Residents’ Care

Exceptionally high turnover among nursing home staff contributes to the staggering number of deaths in facilities during the epidemic, the authors of a new study suggested.

study, Which was published on Monday in the Journal of Health Affairs, takes a comprehensive look at turnover rates at 15,645 nursing homes across the country, accounting for nearly all facilities certified by the federal government. Researchers found that the average annual rate was 128 percent, with some facilities experiencing businesses that exceeded 300 percent.

“It was really shocking,” said David Grabowski, a professor of health care policy at Harvard Medical School and one of the study’s authors. Researchers pointed to the urge to publish medicines to individual nursing home sites at turnover rates, as a way of putting the spotlight on substandard conditions and pressuring owners to make improvements.

Inadequate staffing – and low salaries – for the more than one million residents living in these facilities have long suffered from nursing homes and quality care. But the epidemic has exposed these issues even more rapidly. the inspection Kovid cases are under surveillance of facilities in some states in the form of uncontrolled and skyrocketing deaths.

The high turnover rate made it difficult for nursing homes to bring strong infection control during the epidemic, and led to the widespread spread of coronovirus, said Ashwin Ghandi, lead author and a health economist and assistant professor at the University of California. Los Angeles Anderson School of Management.

Nursing-home owners blame inadequate reimbursement from Medicaid, a federal-state program for elderly skilled nursing care.

The Chief Medical Officer of the American Health Care Association and the National Center for Assisted Living, Drs. “Workforce recruitment and retention is one of the biggest challenges facing long-term care providers, and we have been seeking help for years,” said David Gifford. The business group said in an email statement.

“It is high time that providers receive the appropriate resources to invest in our front-line caregivers to improve quality care,” he said.

Accordingly, by the end of February, there had been at least 172,000 deaths from the virus among residents or employees of nursing homes and other long-term care facilities. A database Compiled by the New York Times. Nursing home deaths account for more than one-third of all Kovid deaths in the United States alone, although the death and case rates have fallen drastically as more than 70 percent of residents have received vaccinations.

Criticism of the industry has also focused on decades of ownership of nursing homes private equity And other private investment firms, which prioritized profits for investors over residents’ well-being. These owners have long been accused of diluting their facilities and reducing workers.

Dr. Gandhi said that labor is one of the main expenses in operating a nursing home. “It’s not an industry with very high margins in general,” he said. “Any facility trying to maximize profits is going to think carefully about the cost of its staff.”

Nursing home staff Resistance also shown Vaccination against coronaviruses, complicating efforts by public health officials and nursing homes to provide blanket vaccination protections for personal convenience. If a nurse who had immunized leaves and has been replaced, the facility will be required to ensure that the new employee is also vaccinated, especially given the reluctance of some workers to receive coronovirus shots. .

Dr. Gandhi said, “Trying to push a one-shot vaccination is not enough.” “You need to be constantly vaccinated.”

Registered nurses, who are the most skilled workers, had the highest rates of turnover, and traded extensively in facilities. The states with the highest rates were Oklahoma, Montana, and Kansas. Facilities with lower star ratings had lower average business rates than nursing homes on the Medicare website, and nursing homes with higher ratings had the lowest turnover. According to the study, turnover was also higher among the for-profit institutions serving chains and Medicaid beneficiaries.

Melissa Unger, executive director of SEIU 503, Oregon Division of Service Employees International Union, said nurses struggle to work at facilities with very few staff members to adequately care for residents.

“You don’t feel very good about the work you are doing”, Ms. Ungar said, noting that many staff members are women and people of color. “You’re doing all that for ugly benefits and low pay.”

Summer Trotsko, a union member who works at an Oregon nursing home, said she was used to colleagues from burnout due to inadequate staffing and lack of money. “They get tired and just can’t take it anymore,” she said. He said that there are many people who have graduated from high school with little training.

In addition to making the turnover rates available to the public, the authors point to a number of steps lawmakers can take to improve retention. Medicare can incorporate turnovers in its star-rating system, and Medicare and Medicaid can reward nursing homes with higher rates if they have lower turnovers. “If we are going to change nursing homes, we have to start with the staff,” Dr. Grabowski said.

The researchers used newly available payroll-based data collected by Medicare & Medicaid Services to calculate turnover rates in 2017 and 2018 for registered nurses, licensed practical nurses, and certified nursing assistants. They looked at the percentage of hours worked by a nursing worker. In a given year and higher rates were calculated if the person leaving had provided more care.

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