Higher staffing levels contribute to better scores on quality measures suggesting that Care Compare for nursing homes could benefit from adding a measure for staffing instability.

This is the recommendation of a study published in the August issue of the Journal of the American Medical Directors Association (JAMDA), which revealed that both staffing instability and turnover play a significant role in nursing home quality.

The study, encompassing data from 11,840 nursing homes, included data from the Payroll Based Journal (PBJ) for daily staffing information and merged it with Nursing Home Care Compare (NHCC) data for nursing home characteristics, total staffing turnover, and nursing home quality.

Researchers weighed indicators of nursing home quality in the NHCC 5-star ratings against average total staffing hours per resident-day, total staffing turnover, and total staffing instability.

One noteworthy discovery was a weak positive correlation between turnover and instability, indicating that certain nursing homes experienced both high instability and high turnover.

“Regression analysis revealed that staffing instability and turnover contributed independently to nursing home quality, with instability having a stronger association with some measures of quality and turnover with others,” researchers said.

However, the research also highlighted distinct associations between staffing instability and turnover with specific quality measures. Staffing instability demonstrated a more robust connection with certain aspects of care, such as the decline in activities of daily living (ADL) performance levels among long-stay residents, the administration of antipsychotic drugs, and the functioning of short-stay residents at discharge.

On the other hand, researchers found turnover exhibited a stronger link with the prevalence of pressure ulcers and worsening mobility among long-stay residents, as well as hospitalizations among short-stay residents.

Overall, researchers advocated for the integration of staffing instability into existing measures of average staffing and staff turnover in the NHCC report card.

“​​Turnover was positively and more strongly associated with the prevalence of pressure ulcers and worsening mobility in long-stay residents and hospitalizations in short-stay residents,” researchers wrote.

In addition to better performance on quality measures in NHCC’s report card, previous research has also shown that higher staffing levels are linked to fewer hospitalizations and emergency department visits, as well as fewer citations for deviations from state and federal quality standards.