Association between Nursing Home Staff Turnover and Infection Control Citations

Abstract

Objective: To describe the association between nursing home staff turnover and the presence and scope of infection control citations.

Data Sources: Secondary data for all U.S. nursing homes between March 31, 2017 through December 31, 2019 from Payroll Based Journal, Nursing Home Compare, and Long-Term Care Facts in the U.S.

Study Design: We estimated the association between nurse turnover and the probability of an infection control citation and the scope of the citation, while controlling for nursing home characteristics and state fixed effects. We measured turnover as the percentage of hours in the 2 weeks prior to the survey date that came from nurses that did not work at least 60 days of the last 180 days. We calculated turnover for all staff together and separately for registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs).

Data collection/Extraction methods: We linked nursing homes health inspection surveys to 650 million shifts from the Payroll Based Journal data. We excluded follow-up surveys in the same inspection cycle. We excluded any nursing home with incomplete or missing staffing data. Our final analytic sample included 14,237 nursing homes with 33,726 surveys.

Principal Findings: Staff turnover was associated with an increased likelihood of an infection control citation (average marginal effect [AME]=2.25 percentage points (pp); 95% Confidence Interval (CI): 1.71,2.78). RN (AME=0.70 pp; 95%CI: 0.07,1.31), LPN (AME=1.27 pp; 95%CI: 0.55,1.99) and CNA (AME=0.86 pp; 95%CI: 0.13,1.60) turnover were all conditionally associated with an infection citation. Staff turnover was positively associated with the infraction scope being coded as a “pattern” (AME=0.83 pp; 95%CI: 0.44,1.21) or “widespread” (AME=0.81 pp; 95%CI: 0.43,1.19).

Conclusions: RN, LPN, and CNA turnover are all positively associated with the probability of an infection control citation. Staff turnover should be considered an important factor affecting the spread of infections within nursing homes.

Keywords: Nursing Home, Infection Control, Health Workforce, Long-term Care, Employee Turnover, COVID19

JEL Classification: I1