Staffing/Turnover
Shortages of Direct Care Workers result in:
Direct Care Workers leaving the field.
Burnout caused by high stress, long hours and mourning the loss of those being served is at an all-time high, and as one Direct Care Worker put it “there is burnout and then there is burnout of no return.”
Diminished quality of care.
High cost of turnover.
The only reliable turnover rates are those in nursing homes as reported on cost reports. The Iowa Department of Health and Human Services prepares a turnover report to the legislature every year. The annual turnover rate of Certified Nursing Assistants in 2022 was 72% with an estimated cost of $123M to the state and employers. It should be noted, however, that some of the turnover can be contributed to Certified Nursing Assistants continuing their education to become licensed nurses, dental hygienists, therapists, human service and mental health workers, and other factors. You can find the most recent report here.
https://hhs.iowa.gov/media/9841/download?inline=
Final rules just released by the Centers for Medicare and Medicaid Services will require mandatory staffing standards for nursing homes. The new rules would be phased in over a three-to-five-year period. Rural entities would have more time to comply with the new rules. https://www.cms.gov/newsroom/fact-sheets/medicare-and-medicaid-programs-minimum-staffing-standards-long-term-care-facilities-and-medicaid-0
Iowa CareGivers recently conducted a survey asking direct care workers and others whether they supported mandatory staffing levels. Those survey findings can be found here:
From Survey Respondents
“I was talking with someone whose mother just passed away. She had to call her family to help her go to the bathroom because she waited over 2 hours to go, and no one answered her light.”
“As a CNA there are times when I have 30 residents to myself. Many 2 assists and complete cares. It’s physically impossible to give PROPER care with ratios like that. They deserve better.”
“As the Assistant Director of Nursing of a small 28 bed, long-term care facility, with the limited RN staff members we have (Director of Nursing, myself, and two other charge nurses) our facility would be unable to meet 24 hours of nursing coverage, without working in constant overtime and flipping shifts regularly. This would result in yet another small-town nursing home closure. We have difficulty finding staff in general, that another regulation this tight could shut us down for good. Our residents are our family and deserve better than this!”
Iowa Nursing Facility Staff Turnover Summary Report 2012 – 2015
Turnover of Certified Nursing Assistant and other nursing home staff has been the subject of many studies over the years, and has been a concern expressed by those working in the field, those residing in nursing homes and their families, employers, and others.
Iowa’s nursing homes have been required, for a number of years, to report their staff turnover by worker classification Certified Nursing Assistant, Director of Nursing, Administrator, Dietary, etc. on their cost reports submitted to the Department of Health and Human Services. The Department is then required to submit an analysis report to the Iowa Legislature annually. Unfortunately, the report to the legislature contains only a list of nursing homes and their turnover rates for each of the designated worker classifications. There is no in-depth analysis on the data being conducted nor was there ever any criteria established by the legislature on what the analysis might include. We have prepared a summary of the turnover data with recommendations on how to better utilize the data. We hope that this report will become a catalyst for further exploration into determining how analysis of the existing data can lead to enhanced quality of care for nursing home residents, and the quality of jobs of those who work in the field. Please contact Di Findley with questions di.findley@iowacaregivers.org