Association between Nursing Home Staff Turnover and Infection Control Citations

Forthcoming, Health Services Research, accepted date: 8/29/2021. https://onlinelibrary.wiley.com/doi/10.1111/1475-6773.13877

34 Pages Posted: 16 Jan 2021 Last revised: 8 Sep 2021

See all articles by Lacey Loomer

Lacey Loomer

University of Minnesota - Duluth

David C. Grabowski

Harvard University - Department of Health Care Policy

Huizi Yu

University of California, Los Angeles (UCLA)

Ashvin Gandhi

University of California, Los Angeles (UCLA) - Anderson School of Management

Date Written: September 1, 2021

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 (PBJ), Nursing Home Compare, and Long-Term Care Facts on Care 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 fixed effects. Our turnover measure is the percent of the facility’s nursing staff hours that were provided by new staff (less than 60 days of experience in last 180 days) during the two weeks prior to the health inspection. We calculated turnover for all staff together and separately for registered nurses, licensed practical nurses (LPNs), and certified nursing assistants.

Data collection/Extraction methods: We linked nursing homes standard inspection surveys to 650 million shifts from the PBJ data. We excluded any nursing home with incomplete or missing staffing data. Our final analytic sample included 12,550 nursing homes with 30,536 surveys.

Principal Findings: Staff turnover was associated with an increased likelihood of an infection control citation (average marginal effect [AME]=0.12 percentage points (pp); 95% Confidence Interval (CI): 0.05,0.18). LPN (AME=0.06 pp; 95%CI: 0.01,0.11) turnover was conditionally associated with an infection control citation. Conditional on having at least an isolated citation for infection control, staff turnover was positively associated with receiving a citation coded as a “pattern” (AME=0.21 pp; 95%CI: 0.10,0.32). Conditional of having at least a pattern citation, staff turnover was positively associated with receiving a widespread citation (AME=0.21 pp; 95%CI: 0.10,0.32).

Conclusions: Turnover was positively associated with the probability of an infection control citation. Staff turnover should be considered an important factor related to the spread of infections within nursing homes.

Keywords: Nursing Home, Infection Control, Health Workforce, Long-term Care, Employee Turnover, COVID-19

JEL Classification: I1

Suggested Citation

Loomer, Lacey and Grabowski, David C. and Yu, Huizi and Gandhi, Ashvin, Association between Nursing Home Staff Turnover and Infection Control Citations (September 1, 2021). Forthcoming, Health Services Research, accepted date: 8/29/2021. https://onlinelibrary.wiley.com/doi/10.1111/1475-6773.13877, Available at SSRN: https://ssrn.com/abstract=3766377 or http://dx.doi.org/10.2139/ssrn.3766377

Lacey Loomer (Contact Author)

University of Minnesota - Duluth ( email )

1049 University Drive
Duluth, MN 55812
United States

HOME PAGE: http://https://lsbe.d.umn.edu/faculty-staff/lacey-loomer-phd-0

David C. Grabowski

Harvard University - Department of Health Care Policy ( email )

25 Shattuck Street
Boston, MA 02115
United States

Huizi Yu

University of California, Los Angeles (UCLA) ( email )

405 Hilgard Avenue
Box 951361
Los Angeles, CA 90095
United States

Ashvin Gandhi

University of California, Los Angeles (UCLA) - Anderson School of Management ( email )

110 Westwood Plaza
Los Angeles, CA 90095-1481
United States

HOME PAGE: http://www.ashvingandhi.com

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