If nursing homes want to improve quality of care, it is imperative that they reduce staff turnover, and focus their efforts more on retention than recruitment.

This is according to a JAMA study released Monday, which also revealed that the average annual turnover rate in nursing homes was as high as 128%, indicating a revolving door of staff.

High staff turnover rates can disrupt the continuity of care, hinder the formation of vital staff-resident relationships, and limit the acquisition of skills and institutional knowledge through on-the-job experience, JAMA researchers said.

“Staff turnover may be particularly important in nursing homes, given the frequency of interactions between staff and residents over an extended period of time,” they wrote.

And while efforts to enhance the quality of care in these facilities have typically focused on increasing staffing levels, recent attention has shifted towards addressing the issue of staff turnover.

The Centers for Medicare & Medicaid Services (CMS) began measuring and publishing turnover rates for all nursing home facilities in 2022 as part of the Nursing Home Compare tool. Some states have begun implementing higher reimbursement rates as a reward for nursing homes that successfully retain staff.

Yet, despite the growing recognition of the importance of staff turnover in nursing homes, researchers said that empirical studies on its effects on the quality of care have been limited.

The latest study found that high staff turnover rates were associated with a decrease in the quality of care provided to residents. Notably, the impact was more pronounced in measures related to patient functioning. For example, an additional 10 percentage points in nursing staff turnover in the two weeks before a health inspection were linked to an additional 0.241 citations in that inspection.

Similarly, nursing staff turnover was associated with a mean decrease of 0.035 standard deviations in assessment-based quality measures and 0.020 standard deviations in claims-based quality measures.