We’ve witnessed COVID-19 ravage our nation’s nursing homes and claim the lives of over 182,000 residents and staff, accounting for one-third of the nation’s death toll. In some states, the percentage of deaths is much higher. In Connecticut, for example, deaths in long-term care facilities account 55 percent of the state’s total deaths. The Center for Medicare Advocacy recently released a report – Geography Is Not Destiny: Protecting Nursing Homes from the Next Pandemic – which, in part, examines how COVID-19 was able to devastate nursing homes. Staffing shortages and high rates of staff turnover were cited as important factors. While exacerbated by the pandemic, these issues have existed for decades.
Analysis published in a recent Health Affairs article – “High Nursing Staff Turnover In Nursing Homes Offers Important Quality Information” – reveals a glimpse of the extent of the staff turnover challenges nursing homes across the country faced before the pandemic. Drawing upon Payroll Based Journal (PBJ) data from 2017-2018, the study found Registered Nurses (RNs) and Certified Nursing Assistants (CNAs) had the highest turnover rates in nursing home facilities. The average turnover rates for RNs was 140.7 percent, while for CNAs it was 129.1 percent. The study also found that facilities with the lowest CMS overall star ratings (one-star) had the highest median turnover rates (135.3 percent), while the facilities with the highest ratings (five-star) had the lowest median turnover rate (76.7 percent).
The Center’s report highlights multiple factors for this high staff turnover, ranging from a pattern of poor working conditions, low pay with little or no benefits, and physically demanding and mentally exhausting jobs.
High staff turnover can hurt the quality of care residents receive resulting in diminished health outcomes. The Health Affairs article states that high turnover rates lead to more rehospitalizations and more frequent use of physical restraints. Additionally, it asserts that high turnover rates could also lead to increased infection control violations, potentially increasing COVID-19 outbreaks in nursing homes.
April 15, 2021 – C. St. John
 KFF, “State COVID-19 Data and Policy Actions” (updated April 12, 2021), available at: https://www.kff.org/coronavirus-covid-19/issue-brief/state-covid-19-data-and-policy-actions/
 Gandhi, A., Yu, H., & Grabowski, D., “High Nursing Staff Turnover in Nursing Homes Offers Important Quality Information” (2021) Health Affairs, 40(3), 384-391. doi:10.1377/hlthaff.2020.00957