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High Turnover in Iowa Nursing Homes Leads to Worse Care Quality

September 15, 2014

High turnover rates in Iowa nursing homes have an adverse effect on the quality of care they can provide, reported an August 17 article in the Gazette of Cedar Rapids, prompting responses from the Iowa CareGivers Association (ICA).

The article found that Iowa nursing homes had an average staff turnover rate of 41 percent each year from 2010 to 2012.

The state government does “very little analysis of [these] turnover numbers,” the article reports, despite some individual nursing homes having turnover rates as high as 218 percent.

High turnover among certified nursing assistants (CNAs), who provide the majority of hands-on care to residents, is associated with significantly higher rates of low-risk pressure ulcers, pain, and urinary tract infections, the article says.

Di Findley, the executive director of the ICA, said that the top reason for high CNA turnover is a lack of training and other supports for these workers.

“The No. 1 reason was not enough help,” Findley is quoted as saying in the article. “They felt like they couldn’t do a good job and would fall short.”

Iowa CareGivers Association Responds

The article inspired several responses by ICA members.

In a September 9 letter to the Des Moines Register, Findley calls for a greater commitment to producing and analyzing turnover statistics in long-term care settings.

She cites a recent “preliminary correlation analysis linking high CNA turnover to nursing home deficiencies” conducted by PHI for the ICA. The analysis found a statistically significant correlation between turnover and quality outcomes, Findley writes.

Findley made similar points in a September 5 letter to the Gazette.

On September 10, John Hale, a former public policy consultant for the ICA, wrote a guest column for the Gazette in which he took nursing homes to task for a business model that relies on a workforce of poorly paid and minimally trained workers.

Unsurprisingly, this model “has led to a revolving door of workers due to inadequate training and compensation, limited career opportunities, too few co-workers to rely on, and too little respect for the work being performed,” Hale writes.

Like Findley, Hale argues that more attention should be paid to turnover statistics. He further argues that public funds should be invested in “compensation, training, recognition and other things that will lead to lower [CNA] turnover and better care for residents.”

Also on September 10, the Des Moines Register published another guest column by Hale. The column outlines the various state government agencies responsible for maintaining quality of care in nursing homes, and explains how those agencies can work more efficiently to improve care quality.

— by Matthew Ozga

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