Nursing homes face high turnover rates

[cougarnurse]

I know this isn't anything really new... the turn over rate. What do you think of the strategies? Hutchinson News Online

When Lois Scott resided in a Hutchinson nursing home, she saw people who appeared so tired it prompted the former home health aide to voice concerns.

The people weren't her fellow residents. They were the ones delivering hands-on care.

Scott's grown children relayed to the nursing home's administration their mother's worry about the long hours that some aides worked.

They replied that they were trying to get more help and they were doing the best that they could, said Scott's daughter, Peggy Miller.

A memory that sticks in Miller's mind was the evening she arrived at the nursing home, heard her mother coughing persistently, and later discovered that the call light for help had been on about 20 minutes.

If Miller had not arrived, Scott would have called another daughter, Cindy Daniels, who lived nearby, and sometimes could be called and arrive in her mother's room before staff responded to the call light, Miller said.

Scott did not blame the aides, Miller said. Indeed, two aides even served as pallbearers at her funeral in 2007.

Scott resided at Good Samaritan Village, 810 E. 30th, which did not return a call from The News.

An administrator at another Reno County nursing facility, however, was quick to volunteer that staffing challenges, exacerbated by high employee turnover, are not unique to Good Samaritan.

A look at nursing staff turnover rates in 2006 - the most recent year for which Medicaid-certified nursing facility numbers are available - revealed that it was common for facilities in south-central and southwestern Kansas to experience a 100 percent turnover in a year for registered nurses, licensed practical nurses and aides.

Statewide, for-profit nursing facilities showed an average turnover rate in aides that exceeded 100 percent, with a lower rate reported for nonprofit institutions.

The most unusual numbers in Reno County were those listed for Deseret Nursing and Rehabilitation, 2301 N. Severance, showing very low employee turnover: 20 percent for registered nurses; 36 percent for licensed practical nurses; and 55 percent for aides.

Deseret administrator Peter Mungai, fairly new on the job, said he wasn't there in 2006 and he could not say if the numbers were accurate. Nursing facilities self-report turnover rates, which are not independently checked.

Currently, Mungai said, Deseret had an opening for a registered nurse.

A 100 percent turnover rate does not necessarily mean a complete change in staff. For example, a nursing facility could have a longtime day-shift employee, but see turnover two or three times in a year's span for the night-shift position, thus affecting the overall turnover rate.

Employee turnover can exact a price, studies have noted.

The employer must spend time and effort to attract and train new employees. Meanwhile, nursing home residents can suffer from the loss of continuity when staff changes and from the unfamiliarity and inexperience of new hires. Further, high turnover can adversely affect the morale of staff.

Consumers would benefit from looking at employee turnover rates when choosing a nursing home, advised a nursing home study completed in 2006 for the Kansas Department of Aging.

The same study, produced through the University of Kansas, pinpointed employee turnover as "the most important factor in predicting nursing home deficiency scores."

The state has not amended its nursing facility staffing regulations in years, said State Rep. Bob Bethell, R-Alden, but nursing homes typically exceed those minimum requirements despite a "real shortage" of individuals who can fill those jobs.

Nursing home employees enjoy a "tremendous amount of job security," said Bethell, who has been a nursing home administrator.

If an employee becomes upset, he can quit and easily find comparable work at another employer, he said.

Some nursing homes, pressed to fill seven-day/24-hour schedules, enlist the help of agencies that send nurses or certified nurse aides to fill the gaps.

"I didn't use them very much," Bethell said, because it's not the ideal situation to mix outside workers, who are able to avoid the undesirable work shifts, with in-house staff.

"We'll have 70 to 80 people working every week," said Monty Strecker, whose Cornerstone Healthcare Inc., Ellinwood, helps labor-short nursing homes.

Some people sign up to work to earn extra money while retaining the flexibility to pick and choose their work schedule, Strecker said, adding that they also avoid "the politics of the facility."

On the other hand, they forgo the comfort of a steady paycheck and have to be prepared financially for periods when they will be short on hours, he noted.

The nursing shortage is not going to change, Strecker said, noting one long-term care facility where four of the 10 nurses are over 70-years-old.

Employment trends "tend to go in cycles," said William Fisher, administrator at Garden Valley Retirement Village, Garden City.

"Right now, almost all of our positions are full," Fisher said recently, but on occasion, Garden Valley Retirement has used various incentives, including signing bonuses, to lure employees.

"I have no explanation for those cycles," said Mary Drake, administrator at Woodhaven Care Center, Ellinwood. However, when overall unemployment rises, Woodhaven receives more applications, she noted.

Both Fisher and Drake credited the benefit of having nursing programs at nearby community colleges - Garden City Community College and Barton County Community College - in producing labor.

"We put our classes in the nursing homes," said Jeanne Miles, a registered nurse and health care coordinator/trainer with Hutchinson Community College.

Students experience the nursing home environment as they study to become a certified nurse aide, she said, reeling off the names of more than five institutions in Reno County that cooperate with HCC on training.

HCC's certified nurse aide program draws "a very broad range" of students, from age 14 up to people approaching retirement, Miles said.

Some people want to obtain the skills to care for family members, while other people are striving for a job that will pay more than flipping burgers, she said.

According to the Kansas Department of Labor's 2008 Job Vacancy Survey, four jobs in the "Top 10 Occupations Always Open" and the average minimum wage offer for those occupations were: nursing aides, orderlies and attendants, $8.92 an hour; retail salesperson, $7.88 an hour; food preparation workers, $7.15 an hour; and waiters and waitresses, $5.86 an hour.

A certain amount of staff turnover is good, said Debra Zehr, executive director of the Topeka-based Kansas Association of Homes and Services for the Aging.

Some employees aren't a match for nursing home work, so their departure is advantageous for all parties, she observed.

Being a certified nurse aide "is a lot of hard work," HCC's Miles emphasized, with aides performing bathing, cleaning and feeding tasks that residents cannot do for themselves.

Twenty years ago, she said, the average nursing home resident needed less intensive care.

Today, the elderly stay home until the family just can't manage it anymore, Miles said, so when they enter a nursing home, care requirements are greater.

Dealing with the dementia and deaths of residents is taxing on aides, too, she noted.

A workplace poll posted online by the American Association of Homes and Services for the Aging showed that 55 percent of direct-care workers said they did not want to be doing that job three years from now.

Another poll finding was that a supervisor's attitude was more significant than wages and benefits in influencing a nursing assistant's commitment to his job and his intent to stay.

"Culture change" is a grassroots approach to turn nursing homes away from an institutional approach to a more home-like environment, for the benefit of residents and staff, according to Marjorie Bott, a registered nurse and associate dean of the University of Kansas School of Nursing.

"It's trying to give residents more say in their schedules and activities - what they eat, when they go to bed - and empower staff so they have a say in their schedules and work life," Bott said.

At Pleasant View Home, Inman, job applicants are interviewed by employees with whom they would work, as well as some residents.

"We have fully embraced person-centered care and culture change," said Pleasant View Home chief executive officer Kevin Reimer. "Part of that is to empower the staff and have the staff make decisions at the floor."

Pleasant View Home administrator Jalane White recalled one question a resident posed to an applicant: "'Do you like old people?'"

Mennonite Friendship Manor, South Hutchinson, has incorporated the new approach at its 10-resident Wheaton Green House, and one of the part-time aides is Miller.

Her mother inspired her to take the training, Miller said.

Miller once, very briefly, switched from the nursing- home setting to the hospital.

"I missed the old people; I had to go back," she said.