There is general agreement among policy makers and providers that high turnover rates among direct-care workers hurt care quality and need to be lowered. But we can’t even define the scope of the problem, let alone assess how effective interventions may be, without a consistent method of measuring turnover, according to a study published in The Gerontologist Vol. 48, No. 3.

Measuring Worker Turnover in Long-Term Care: Lessons From the Better Jobs Better Care Demonstration discusses and charts various ways of calculating turnover. Those differences likely account for a significant amount of the wide variation in reported rates, it says. For example Florida’s relatively low turnover rate is probably due to the fact that the state doesn’t count workers until they’ve completed their first three months of employment, when turnover is typically at its highest.

Reported rates vary widely within long-term care settings (nursing homes, home care, and assisted living) as well as between different settings and geographic regions. Recent estimates of nursing home turnover rates range from 25 percent in Hawaii to 127 percent in Wisconsin. In home care, reported turnover rates range from 12 percent to 76 percent.

Researchers and policymakers should be cautious in comparing turnover rates, the researchers warn. “More important, states using a provider’s turnover rate as one criterion for receiving higher reimbursement as part of a pay-for-performance policy must carefully prescribe the calculation of turnover and subject it to audit.”

The paper discusses ways of calculating turnover that policy makers and providers may find useful. It is free to subscribers only; others must pay $20.

Elise Nakhnikian, Senior Online Editor
enakhnikian@phinational.org