Karen Shen, PhD: High Turnover Rates in Nursing Homes


Shen discusses her team’s research into the link between high turnover rates in US nursing homes and worsened quality of care.

A new study led by Karen Shen, PhD, of the department of health policy at Johns Hopkins Bloomberg School of Public Health, found a link between high turnover rates in nursing homes and decreased quality of care.

In an interview with HCPLive, Shen discussed the rationale and challenges behind the study as well as what clinicians and health professionals can do to combat the high turnover rates in nursing homes.

“I think the most important takeaway of our study is essentially the title of the study, which is that staff turnover in nursing homes seems to negatively affect quality of care for the residents of those homes,” Shen told HCPLive. “What we have done is improved upon previous studies by looking at times within the exact same facility where those facilities are you experiencing high, high or low turnover, and found that in times of high turnover, those facilities also experienced lower quality of care.”

After hearing about the frequent policies striving to improve staffing levels, Shen researched staffing. But when she struggled to find “convincing recent evidence” of how staff turnovers affect quality of care in nursing homes, she knew it would be a good research path to pursue. The study inevitably brought challenges, as the research included a lot of quality-of-care data, but citations change over time.

“What deficiencies state investigators are looking for, as well as what quality measures they use, has changed over the period of our study,” Shen explained.

Because of this, Shen and her team had to scour through the data to make sure everything was consistent over time.

“On the staffing side of things, we had to pull daily payroll data, for every employee, look at whether or not they left the facility in a given time period, so that ended up being quite a big lift,” Shen said.

When asked what health professionals could do to lower staff turnover rates in nursing homes, Shen explained how that would most likely be up to the facility operators.

“I think that facility operators need to consider, especially with new staffing mandates coming in, what they are also going to do about addressing the high rates of staff turnover,” Shen said.

Shen highlighted policy reform ideas that could potentially help improve staff turnover rates.

“There has been a lot of work that looks at potential determinants of staff turnover,” Shen said. “So how work is structured inside a facility, and whether people are receiving higher wages or benefits, and I think those are all important to ensure that the residents of facilities get to experience care from kind of continuous care from longer tenured staff.”

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