Unhealthy exodus
High employee turnover rate at state’s nursing homes is a threat to patient care.
Texas nursing facilities have one of the highest turnover rates in the country. As unlikely as it seems given the nationwide protests for higher wages in the fast food industry, some nurses and nursing home medical staff are leaving for the Golden Arches, not to buy a burger but for a higher-paying job, as recently reported in the Dallas Morning News.
Last week, state lawmakers conducted fact-finding meetings ahead of next year’s legislative session to discuss the high turnover rates of nurses and staff at nursing homes. The annual turnover rate in the state’s nursing homes for registered nurses is 94 percent, for licensed vocational nurses 86 percent, and for certified nursing assistants, 104 percent, as calculated by Texas Health Care Association, a nonprofit organization.
About 85 percent of Texans in nursing homes depend on Medicaid or Medicare. The state’s low Medicaid reimbursement rate contributes to the revolving door at nursing home facilities.
High turnover is bad for patient outcomes and is tied to more bedsores and more use of restraints, catheters and moodaltering drugs. While experts agree that nursing home residents get better care from experienced staff who know them and are familiar with their health history, the fiscal costs of turnover are not as welldocumented.
At the committee hearing, Rep. Four Price, R-Amarillo, suggested an analysis that compares the costs of raising wages versus the costs of high turnover. A thoughtful analysis is a good idea and would likely expose the shortsightedness of a policy that underpays caregivers in an industry where continuity of care can impact patient health.
When someone quits, a facility must pay replacement costs — from advertisement, to fees to employment agencies, to the costs of human resources personnel engaged in interviews and the hiring processes. A nursing facility must then train the new hire in the facility’s policies and work procedures. The higher the turnover, the more training the facility needs to provide, and the higher the training costs it incurs. Furthermore, if patient oversight suffers, patients may get sicker, raising the cost of their care.
But increasing the Medicaid reimbursement rate is not the only way to improve the continuity of care. Texas could study the nursing facilities with the lowest turnover rates and encourage industry-wide best practices. Cultural-change initiatives can make aides’ jobs more fulfilling by offering better training, more responsibility and more respect from superiors.
Whatever solution is chosen, nursing homes residents and their families deserve better than the care currently provided by the many one- and two-star facilities in Texas. Texas has the highest percentage of one-and two-star homes in the country, according to a 2015 analysis by the Kaiser Family Foundation.
It’s a disgrace that the industry that cares for our community’s elders follows a model similar to that of the fast food industry, which hires low-skilled workers, keeps training costs and pay low and relies on a supply of new workers to fill positions.
With the state’s 65 and older population booming, lawmakers must stop paying lip service to protecting seniors and get serious about providing continuity of care for our aging population.