Retention and Turnover

Retention and Turnover

McKnight’s reported on staffing challenges in the nursing home industry. Staffing problems have plagued long-term care operators for decades. It has gotten even worse this year during the coronavirus pandemic. Experts predict unsafe staffing will continue as the crisis further progresses this year.

The ongoing shortage of caregivers will harm nursing homes residents. Staffing has been among the top concerns and expenses for operators. Multiple studies link quality of staffing to how well nursing homes fare with COVID-19. Facilities with more nurse aide hours and training had lower odds of experiencing a coronavirus outbreak and fewer deaths.

David Grabowski is one of the nation’s top health policy analysts. He is a health care policy professor at Harvard Medical School. He warned:

“The amount of fatigue that the direct caregivers are feeling right now is going to begin to manifest itself in individuals leaving the workforce, choosing a different profession. Our direct caregivers haven’t been supported going back really to the beginning of the pandemic, in terms of either pay or personal protective equipment and testing. I think at some point they’re going to evaluate their options and just say, ‘We can’t do this anymore,’” he added. “We’re already seeing a lot of vacancies and workforce shortages.”

The problems with short staffing at nursing homes will not get better until CMS mandates a minimum of 4.1 hours per patient day.


Several stressors lead to high levels of pressure and nurse burnout. These include:

  • Low wages and Lack of benefits
  • Unsafe staffing levels with High patient acuity (years ago, these patients would have been in the hospital)
  • Interruptions while on their break
  • Asking to work outside their scope of practice
  • Inadequate training and Lack of support and resources
  • The expectation that nurses are all-giving. High nurse-to-patient ratios (not needs or acuity-based)
  • Multiple discharges and admissions during their shift
  • Physicians who expect nurses to drop everything and attend to their needs

Living Wage

A LeadingAge analysis released found that raising direct workers’ pay to a living wage would increase their wages by an average of 15.5%. The analysis noted that benefits for a living wage would extend to operators with less turnover and more productivity. Any additional bailout funds to the nursing home industry should be spent on direct caregiver wages.  Much of the bailout money was diverted to real estate and management fees to related entities. Grabowski further lamented:

 “I actually think going forward it may get much worse, especially going into the fall if we see another surge. I think both existing workers are leaving the workforce but also potential workers that you might recruit (will stay away). We just haven’t been able to grow this workforce during the pandemic. It’s going to be really hard to recruit individuals into nursing home positions,” Grabowski explained