What the new CMS staff turnover data means for nursing homes

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Ben Tengelson, VP of Data Science at IntelyCare

To make it easier for families and caregivers to assess the quality of nursing homes, the Center for Medicare & Medicaid Services (CMS) regularly releases data on its “Compare treatmentswebsite. Anyone can access the site and search for a facility to find COVID updates, quarterly quality scores, and information on inspections, penalties, ownership, and more.

Last month, CMS added additional metrics to how it rates nursing home quality. The information is now available for public consumption and will be considered in CMS’s facility quality scores from July 2022.

Staff turnover

Weekend staffing levels (nursing staff hours per resident per weekend day)

Admin turnover

Staffing has become a national issue affecting most industries, especially healthcare. Long-term care is particularly affected, as more than 400,000 providers have left since the start of the pandemic. This is why it is very important to understand the new measures, as they will impact your property’s star rating and ultimately the reimbursement seen by CMS. To help you, we’ve spent some time doing market research and analysis to share with the wider long-term care community.

With more and more nursing professionals looking for new ways to work and a deeper understanding of how things like COVID and weekend work preferences impact the ability to maintain appropriate staffing levels, one thing is abundantly clear: care homes will need to find ways beyond their full-time staff. to maintain their reputation with CMS.

Here’s what we found.

The national average turnover in nursing homes is around 52%

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About half of all nursing homes have an average turnover between 40% and 60%. It is important to note that turnover is not measured at the job level but at the person level. This means that if I owned a nursing home and had to renew a given position twice in 12 months, my turnover would be 66% (in all, I employed three nurses and two of them Are gone).

Staff turnover varies widely by state

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In general, nurse turnover is lower in the Northeast and higher in the South and Central United States. Oklahoma’s average turnover of 61% is the highest in the nation. While Hawaii has the lowest turnover nationally with 32%. California and Alaska also have relatively low turnover.

Average Nursing Turnover Correlates With State Average Attrition Rates

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As much as nursing homes struggle with staff retention, so many other industries are also feeling the same pain. States with higher nursing turnover generally have higher quit rates across all industries as reported by the Bureau of Labor Statistics.

Why is it? It is possible that nursing homes and other industries are similarly influenced by state-level economic factors such as minimum wage laws, labor market conditions, and the availability of nursing services. child care.

Staffing levels matter

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Understaffed facilities, characterized by fewer adjusted staffing hours per resident per day, tend to have higher turnover rates than facilities with better staffing ratios.

While it is true that staffing levels play an important role in preventing burnout among nursing professionals, it is also possible that higher turnover leads to less desirable staffing levels. Until now, there was no way to quantify this relationship. We now know that turnover rates differ by about 10 percentage points between the bottom and top quintiles of adjusted staffing hours per resident per day.

AIs love their weekends

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CMS has a long history of reporting staffing hours per resident per day. But now that we have staffing hours per resident per day on weekends, we can look at the difference between all-week and weekend-only staffing metrics for RNs to identify what we call our “weekend relaxation score”. If a nursing home averaged 5 hours of RN staff per resident for the entire week and 3 hours of RN staff per resident on weekends, it would have a weekend relaxation score of 2 (5 minus 3).

Based on this weekend relaxation score, the median RN turnover rate among the top and bottom nursing home quintiles differs by 20 percentage points! This means RNs stay longer at establishments that give them a weekend break.

Facilities with new owners have the most turnover

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Just under 10% of nursing homes have changed ownership in the last year. Those installs with a new owner have a median turnover rate of 68%, about 17 percentage points higher than installs without a change in ownership.

While this does not prove that new ownership leads to higher turnover, it is possible that higher turnover will lead to a change in ownership.

About half of care homes have had administrative leave

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Turnover is not just limited to nurses. CMS also shows how many administrators have left each retirement home in the last 12 months. Almost half of care homes saw an administrator leave during the reporting period. Some installations (not shown in the table for readability) have lost up to 30 administrators.

5-Star Nursing Homes Are Better For Retaining Nurses

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CMS communicates on the quality of nursing homes through several star ratings associated with specific dimensions (staff, health results, etc.), as well as an overall star rating. As of February 2022, nurse turnover is not directly factored into star ratings, but will be later this year.

1-star nursing homes have a median turnover rate of 60%, while 5-star nursing homes have a median turnover rate of around 45%. The average nurse will stay more than 6 months longer in a 5 star establishment than in a 1 star establishment.

What about COVID?

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Staff turnover is lower in facilities with lower numbers of covid cases. Higher vaccination rates, better access to PPE and other efforts to mitigate the spread of covid are associated with greater staff retention.

Some of this variation is likely due to geography. States like Oklahoma and Missouri have the highest nurse turnover rates and relatively low vaccination rates. Hawaii, on the other hand, has the lowest turnover rate and a relatively high vaccination rate. But geographic patterns notwithstanding, it’s no secret that covid has wreaked havoc on the nursing community and we expect it to have a connection to staff turnover rates.

How a recruitment platform can help you

The macro patterns behind staff turnover in nursing homes reveal an industry facing systemic challenges. Understaffed facilities, characterized by fewer adjusted staffing hours per resident per day, tend to have higher turnover rates than facilities with better staffing ratios. They are also more likely to have a lower STAR rating, which will ultimately jeopardize their refund from CMS. This will only exacerbate their staffing problems. To break free from this unsustainable model, nursing homes must take advantage of technological solutions and adopt new approaches to staffing. Now is the time for care homes to take a look at their staffing options – before it’s too late.


About Ben Tengelson

As Director of Data Science at IntellyCare, an AI-powered nurse staffing platform that schedules and matches nursing professionals with open assignments in healthcare organizations nationwide. In his role at IntelyCare, Ben leads a brilliant team of data scientists and analysts in our mission to drive as much value as possible from IntelyCare data.

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