Nursing facilities with higher turnover rates also saw lower overall scores in CMS' Nursing Home Compare Five-Star Quality Rating System, as well as lower scores on health inspections and quality measures, the report found.
Higher turnover rates also were recorded in poorer regions where pay is likely lower; in for-profit facilities and ones with chain ownership. Sites with higher levels of Medicaid residents also saw higher turnover, and they may pay less because Medicaid reimbursement is lower than Medicare or private payment, according to the report.
"If we believe nursing staff turnover is an indicator of low quality or itself is directly bad for patients, this is yet another way in which the typical inequalities we observe in access to quality care and receipt of care are experienced," Gandhi said. "This is yet another way in which there is a quality divide."
The paper's authors recommend including nursing staff turnover rates on Nursing Home Compare to give potential patients, as well as potential employees, more information when choosing a facility.
"I think it would help patients identify higher-quality facilities. It would place pressure potentially on facilities to try to retain staff," Gandhi said. "For us, more information is going to be better for patients. It will potentially relate to better long-term outcomes. If this is important to patients, it will become important to facilities."
The American Health Care Association and the National Center for Assisted Living, which represents more than 14,000 long-term care facilities, could not be reached for comment.
The researchers were able to calculate turnover rates using newly available payroll data that CMS was mandated to be collected by the Affordable Care Act starting in July 2016; they weighted turnover by the number of hours of care each worker provided.
With turnover data now available, researchers will be able to look at how those rates relate to health outcomes. But Gandhi said it also is important to consider overall wellness of residents, as well, those measures that can't be as easily calculated, such as familiarity with staff and isolation and loneliness.
Turnover rates also can be used to inform vaccination policies in nursing homes, Gandhi said.
"A one-time vaccination push may miss a lot of future incoming staff. We may need to go back again and again to ensure that all the staff who want vaccinations are able to get them," Gandhi said.
