PUBLISHED: July 27, 2023
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This study examines how measures of staffing—turnover and instability—are associated with one another and how they independently contribute to quality of care in nursing homes.  A total of 11,840 nursing homes nationally reporting data on daily staffing and staffing turnover.

For the 11,840 nursing homes in the study, there was a weak positive correlation between turnover and instability, with some overlap between nursing homes with high instability and high turnover. Regression analysis revealed that staffing instability and turnover contributed independently to nursing home quality, with instability having a stronger association with some measures of quality and turnover with others. Staffing instability was positively and more strongly associated with long-stay residents’ decline in activities of daily living levels and receipt of antipsychotic drugs and short-stay residents’ functioning at discharge. Turnover was positively and more strongly associated with long-stay residents’ prevalence of pressure ulcers and worsening mobility, and short-stay residents’ hospitalizations.

Instability and turnover in total nursing home staffing independently contribute to nursing home quality. This suggests that adding measures of staffing instability to the existing measures of average staffing and staff turnover in NHCC may enhance the report card’s value for providers engaged in quality improvement and consumers searching for high-quality nursing homes.

Sinha, Soham, et al. “New Dimensions of Staffing Patterns in Nursing Homes and Nursing Home Quality: Comparing Staffing Instability to Staffing Turnover.” Journal of the American Medical Directors Association, vol. 24, no. 8, Elsevier BV, Aug. 2023, pp. 1099-1105.e7. https://doi.org/10.1016/j.jamda.2023.04.009.