Clint Maun, CSP
Long Term Care Turnover
According to the National Clearinghouse on the Direct Care Workforce, direct-care workers provide an estimated 70 to 80 percent of the paid, hands-on long term care and personal assistance received by Americans who are elderly, chronically ill, or living with disabilities. These workers go by many names, but they fall into three main occupational categories: nursing assistants (usually known as certified nursing assistants or CNAs), home health aides, and personal and home care aides.
According to a study by the American Health Care Association, annual turnover rates among the long term care industry are approximately 70 percent. In other words, two out of three nursing home or long term care workers leave their jobs in the course of a year.
The direct-care worker at a glance
Nine out of ten direct-care workers are women.
The average age of workers in nursing homes is 37; in home care is 41.
Slightly over half of direct-care workers are white and non-Hispanic. About one-third are African-American; the rest are Hispanic or other ethnicities.
Marital Status and Children
A quarter of the direct-care workers in home care and nearly a third of those in nursing homes are unmarried and living with children, compared to 11 percent of the total U.S. workforce.
Forty-one percent of direct-care workers in home care and half of those in nursing homes completed their formal education with a high school diploma or a GED. Another 38 percent of those in home care and 27 percent of those in nursing homes attended college.
Source: William J. Scalon, GAO Testimony: Nursing workforce: Recruitment and retention of nurses and nurse aides is a growing concern
Currently, direct care work is physically and emotionally demanding. These workers leave the field for a variety of reasons, including:
- low wages - according to the U.S. Bureau of Labor, almost a fifth of direct-care workers—far more than the national average of 12 to 13 percent—earn incomes below the poverty level. Furthermore, there is great discrepancy between wages for workers in institutions and those who work in personal homes. In a hospital, an aide gets about $18,000 per year. In a nursing home, they may get $15,000 and, in a residential care home, it can be only around $12,000.
- limited opportunities for advancement
- lack of appropriate training
- lack of benefits - one-third of home care aides (32.1 percent) and a quarter (25.2 percent) of CNAs in nursing homes have no health insurance, compared to one-sixth (16 percent) of all U.S. workers.
- poor public image
- lack of respect
- exclusion from patient-care planning
Good direct-care workers—nursing assistants, home health aides and personal care attendants—are essential to high-quality, long-term care for seniors and the disabled because they provide the bulk of hands-on, paid care for these populations. Unfortunately, there is a severe shortage of these workers, and it will likely worsen as the baby boomers age. The Bureau of Labor Statistics estimates that personal and home care assistance will be the fourth-fastest growing occupation by 2006, with a dramatic 84.7 percent growth rate.
A Regional Sample
The national statistics above should help give you a better idea of what the nation is facing when it comes to filling job vacancies among the long term care industry. Of course, turnover rates do vary a bit from state to state. Below are some turnover rates from a few different states across the nation.
In the Midwest
The average turnover rate in nursing homes in Iowa is estimated at 80 percent and is reported to be as high as 200 percent in some facilities.
In the South
According to the Department of Health and Human Services turnover rates in North Carolina for direct-care workers in home-care agencies averaged 39 percent; in nursing homes, 95 percent; in adult-care homes, 115 percent.
In the East
In Vermont, a study commissioned by the Vermont Department of Aging and Disabilities found that turnover rates range from 35 to 60 percent in nursing homes and home health agencies and are up to 400 percent in residential care homes.
Staff Turnover Among Hospitals
Staff turnover rates have a significant financial impact on hospitals in both time and money. According to VHA Inc, a national health care cooperative, current data shows a turnover rate in hospital health care staffing of 20.7 percent—for all positions. In other words, it’s not just nurses and aides who are quitting. Professionals such as radiology technologists, respiratory therapists and even physicians are all showing signs of a severe to moderate shortage.
However, their reasons for leaving do not closely resemble those of the long term care sector. More and more hospital healthcare staff is leaving a system they feel compromises their medical integrity—one that ultimately puts cost control above patient care. Replacement costs, lost productivity, and temporary staffing cost hospitals between 50 and 150 percent of an individual’s base salary. At a 100 percent turnover cost factor, a turnover rate of 20 percent could cost a hospital on average of $5.5 million a year. In an attempt to manage costs, many hospitals have, over the years, reduced nursing staff, which in some cases has compromised quality of care and patient safety.
Many hospitals have been able to focus on one or two primary aspects of turnover and subsequently see success. For example, hospitals that improve employee satisfaction witness an average increase in revenue per employee. And in hospitals where employee satisfaction is high, the turnover rate is less than 10 percent. Conversely, hospitals with dissatisfied employees see turnover rates of 25 percent or more. So, while the costs of turnover is staggering for hospitals, they do not face the same magnitude of vacancy problems as the long term care industry.
Source: VHA Inc. "The Business Case for Work Force Stability"