Employee Turnover in the Long-Term Care Industry: 2004 NNAS and NNHS Data William Even Miami University & David Macpherson Florida State University
Background Employment in nursing and residential care facilities grew from 2.0 to 2.7 million between 1992 and 2002 Projected to grow to 3.7 million by 2012 (BLS) 6 million by 2050 (DHHS). Florida First in percentage of people over age 75 8.9 percent in Florida 5.0 percent in California
Turnover in LTC Decker et al. 2003: turnover is 70 percent for certified nursing assistants 50 percent for nurses 100,000 FTE vacancies at nursing homes GAO (2001): turnover among nurse aides working in nursing homes is: 13-18% percent higher than the overall labor force 20% higher than other service workers.
Turnover in LTC Turnover is costly Screening, training, reduced quality of care. Replacement cost for nursing home assistant = 4 months salary (Pillemer 1996)
Turnover in LTC Why is turnover so high? (HHS 2002, 2003) wages and benefits working conditions training staffing levels potential for career advancement
Project Objectives Does the measure of turnover or data set affect conclusions? What factors influence the level of turnover? How does exposure to turnover differ across race and gender for nursing home residents?
2004 National Nursing Assistant Survey (NNAS) Supplement to 2004 National Nursing Home Survey (NNHS) 3,017 Nursing Assistants surveyed at 582 nursing homes Four turnover measures How much turnover is there of nursing assistants at facility? How likely is it that NA leaves current job during next year? Is NA currently looking for different job, either as a nursing assistant or something else? Job tenure (in months)
Turnover Analysis of NNAS Methodology: Logit for Looking for Different Job, How Much Turnover at Facility, How Likely Will Leave Job in Next Year, How Much Does Turnover Interfere Demographic Characteristics: Age and Age^2 Female (-) Hispanic (+) African-American Asian Years of Schooling English Main Language Spanish Main Language U.S. Citizen
Turnover Analysis of NNAS Married Divorced or Separated (+) Training: Received Training Before 1987 Employer Paid All Training Costs Employer Paid for Some Training Trained in Nursing Facility Trained in Community College Compensation: Hourly Wage (-) In Pension Plan In Health Insurance Bonuses (-)
Turnover Analysis of NNAS Tenure/Working Conditions: Tenure (-) Work Mandatory Overtime (+) Desire to Work More Hours (+) Desire to Work Fewer Hours (+) # Times Injured at Facility Time Off for Good Work (-) Percent Union Facility Characteristics: Facility Part of Chain For Profit Facility Clusters of Beds for Alzheimer's and Related Dementias (+) Cluster of Beds for Behavior Unit (Non-Alzheimer's) Cluster of Beds for Rehabilitation Number of Beds
Turnover Analysis of NNAS Facility Characteristics: Occupancy Rate Percent of Patients on Medicare Percent of Patients on Medicaid Does Facility Have a Waiting List? Director of Nursing Tenure (-) Medical Director Tenure Nursing Hours Per Patient Per Day (-)
2004 NNHS Data Survey of 1174 facilities Three turnover measures Percent of FTE workers who left in prior 3 months left percent=(number FT workers who left + .5*number PT workers who left)/number of FTEs Percent of FTE positions vacant Percent of workers with at least one year of job tenure Analyze Data with Tobit models
Conclusions • Turnover is a significant problem for nursing homes. • Working conditions and compensation affect level of turnover • Little evidence that facility type (size, case mix) affects turnover • Significant racial differences in the age, health, and payments methods for nursing home residents • Despite these differences, there are only modest racial differences in resident exposure to turnover.