Measuring Worker Turnover in Long-Term Care

Lessons from the Better Jobs Better Care Demonstration

The high turnover of direct-care workers in long-term care is challenging to both policy-makers and provider organizations, and many interventions have been tried in an effort to improve staff retention. Staff turnover is not only costly, but can also lead to disruptions in continuity of care for residents and clients.

In this article, the authors draw on their experience from the national study—Better Jobs Better Care (BJBC) Demonstration —to explain the important issues involved in measuring and interpreting turnover. Insuring comparable measures of turnover is critical in monitoring the effects of interventions designed to reduce staff from leaving and in implementing “pay-for-performance” initiatives where staff turnover rates may be an indication of quality of care. The authors describe how Penn State created a management information system that collects data that were used in creating comparable turnover rates. The researchers found that a difference in definitions was a key reason for inconsistent measures among long-term care organizations. For instance, how turnover is calculated and who is included in the population of interest both affect the turnover rates reported by different providers.

In order to have a standardized measure, policy-makers must develop common definitions and the same data elements.