Employee Turnover in Employee Turnover in the Long-Term Care the Long-Term Care Industry: 2004 NNAS Industry: 2004 NNAS and NNHS Data and NNHS Data William Even William Even Miami University Miami University & & David Macpherson David Macpherson Florida State University Florida State University
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Employee Turnover in the Long-Term Care Industry: 2004 NNAS and NNHS Data William Even Miami University & David Macpherson Florida State University.
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Employee Turnover in the Employee Turnover in the Long-Term Care Industry: Long-Term Care Industry:
2004 NNAS and NNHS 2004 NNAS and NNHS DataData
William Even William Even Miami UniversityMiami University
& & David Macpherson David Macpherson
Florida State UniversityFlorida State University
BackgroundBackground Employment in nursing and Employment in nursing and
residential care facilities residential care facilities • grew from 2.0 to 2.7 million between grew from 2.0 to 2.7 million between
1992 and 20021992 and 2002• Projected to grow to Projected to grow to
3.7 million by 2012 (BLS)3.7 million by 2012 (BLS) 6 million by 2050 (DHHS).6 million by 2050 (DHHS).
FloridaFlorida• First in percentage of people over age 75First in percentage of people over age 75
8.9 percent in Florida8.9 percent in Florida 5.0 percent in California5.0 percent in California
Turnover in LTCTurnover in LTC Decker et al. 2003: turnover is Decker et al. 2003: turnover is
• 70 percent for certified nursing assistants 70 percent for certified nursing assistants • 50 percent for nurses50 percent for nurses• 100,000 FTE vacancies at nursing homes100,000 FTE vacancies at nursing homes
GAO (2001): turnover among nurse GAO (2001): turnover among nurse aides working in nursing homes is:aides working in nursing homes is:
• 13-18% percent higher than the overall 13-18% percent higher than the overall labor forcelabor force
• 20% higher than other service workers.20% higher than other service workers.
Turnover in LTCTurnover in LTC
Turnover is costlyTurnover is costly• Screening, training, reduced quality Screening, training, reduced quality
of care.of care.• Replacement cost for nursing home Replacement cost for nursing home
Why is turnover so high? Why is turnover so high? (HHS 2002, (HHS 2002, 2003)2003)
• wages and benefitswages and benefits• working conditionsworking conditions• trainingtraining• staffing levelsstaffing levels• potential for career advancementpotential for career advancement
Project ObjectivesProject Objectives
Does the measure of turnover or Does the measure of turnover or data set affect conclusions?data set affect conclusions?
What factors influence the level of What factors influence the level of turnover?turnover?
How does exposure to turnover How does exposure to turnover differ across race and gender for differ across race and gender for nursing home residents?nursing home residents?
2004 National Nursing Assistant 2004 National Nursing Assistant Survey (NNAS)Survey (NNAS)
Supplement to 2004 National Nursing Home Survey Supplement to 2004 National Nursing Home Survey (NNHS) (NNHS) • 3,017 Nursing Assistants surveyed at 582 nursing 3,017 Nursing Assistants surveyed at 582 nursing
homeshomes Four turnover measuresFour turnover measures
• How much turnover is there of nursing assistants at How much turnover is there of nursing assistants at facility?facility?
• How likely is it that NA leaves current job during How likely is it that NA leaves current job during next year?next year?
• Is NA currently looking for different job, either as a Is NA currently looking for different job, either as a nursing assistant or something else?nursing assistant or something else?
• Job tenure (in months)Job tenure (in months)
50.73
29.68
16.81
2.776
010
2030
4050
Per
cent
a lot some a little noneHow much turnover of NAs is there at facility
72.02
3.758
24.22
020
4060
80P
erce
nt
no thinking about it yesIs NA Looking for a Different Job
54.81
27.44
17.75
020
4060
Per
cent
not likelysomewhat likelyvery likelyHow likely will NA leave current job in next year
Figure 1: Turnover Measures
05
1015
20P
erce
nt
0 5 10 15 20 25Years
Figure 2: Job Tenure for Workers Employed at Least 1 Yr
33.93
29.53
15.31
21.23
010
2030
40P
erce
nt
a lot some a little noneHow much does turnover interfere with NAs ability to do job
Figure 3: How Much Does Turnover Interfere With NAs Job
29.77
70.23
020
4060
80P
erce
nt
No YesWorkload
63.87
36.13
020
4060
Per
cent
No YesMust Spend Time Training Other NAs
84.52
15.48
020
4060
80P
erce
nt
No YesAffects Workplace Morale
85.43
14.57
020
4060
80P
erce
nt
No YesOther
Figure 4: Reason Turnover Affects Job
Turnover Analysis of NNASTurnover Analysis of NNAS Methodology:Methodology:
• Logit for Looking for Different Job, How Much Turnover at Logit for Looking for Different Job, How Much Turnover at Facility, How Likely Will Leave Job in Next Year, How Much Facility, How Likely Will Leave Job in Next Year, How Much Does Turnover InterfereDoes Turnover Interfere
Demographic Characteristics:Demographic Characteristics:• Age and Age^2Age and Age^2• Female (-)Female (-)• Hispanic (+)Hispanic (+)• African-AmericanAfrican-American• AsianAsian• Years of SchoolingYears of Schooling• English Main LanguageEnglish Main Language• Spanish Main LanguageSpanish Main Language• U.S. CitizenU.S. Citizen
Turnover Analysis of NNASTurnover Analysis of NNAS• MarriedMarried• Divorced or Separated (+)Divorced or Separated (+)
Training:Training:• Received Training Before 1987Received Training Before 1987• Employer Paid All Training CostsEmployer Paid All Training Costs• Employer Paid for Some TrainingEmployer Paid for Some Training• Trained in Nursing FacilityTrained in Nursing Facility• Trained in Community CollegeTrained in Community College
Compensation:Compensation:• Hourly Wage (-)Hourly Wage (-)• In Pension PlanIn Pension Plan• In Health InsuranceIn Health Insurance• Bonuses (-)Bonuses (-)
Turnover Analysis of NNASTurnover Analysis of NNAS
Tenure/Working Conditions:Tenure/Working Conditions:• Tenure (-)Tenure (-)• Work Mandatory Overtime (+)Work Mandatory Overtime (+)• Desire to Work More Hours (+)Desire to Work More Hours (+)• Desire to Work Fewer Hours (+)Desire to Work Fewer Hours (+)• # Times Injured at Facility# Times Injured at Facility• Time Off for Good Work (-)Time Off for Good Work (-)• Percent UnionPercent Union
Facility Characteristics:Facility Characteristics:• Facility Part of ChainFacility Part of Chain• For Profit FacilityFor Profit Facility• Clusters of Beds for Alzheimer's and Related Dementias Clusters of Beds for Alzheimer's and Related Dementias
(+)(+)• Cluster of Beds for Behavior Unit (Non-Alzheimer's)Cluster of Beds for Behavior Unit (Non-Alzheimer's)• Cluster of Beds for RehabilitationCluster of Beds for Rehabilitation• Number of BedsNumber of Beds
Turnover Analysis of NNASTurnover Analysis of NNAS
Facility Characteristics:Facility Characteristics:• Occupancy RateOccupancy Rate• Percent of Patients on MedicarePercent of Patients on Medicare• Percent of Patients on MedicaidPercent of Patients on Medicaid• Does Facility Have a Waiting List?Does Facility Have a Waiting List?• Director of Nursing Tenure (-)Director of Nursing Tenure (-)• Medical Director Tenure Medical Director Tenure • Nursing Hours Per Patient Per Day (-)Nursing Hours Per Patient Per Day (-)
2004 NNHS Data2004 NNHS Data Survey of 1174 facilitiesSurvey of 1174 facilities Three turnover measuresThree turnover measures
• Percent of FTE workers who left in prior 3 Percent of FTE workers who left in prior 3 monthsmonths
left percent=(number FT workers who left left percent=(number FT workers who left + .5*number PT workers who left)/number of + .5*number PT workers who left)/number of FTEsFTEs
• Percent of FTE positions vacantPercent of FTE positions vacant• Percent of workers with at least one year Percent of workers with at least one year
of job tenureof job tenure Analyze Data with Tobit modelsAnalyze Data with Tobit models
01
02
03
04
05
06
0P
erc
en
t
0 20 40 60 80 100RN
Median is 0 percent
01
02
03
04
05
06
0P
erc
en
t
0 20 40 60 80 100LPN
Median is 6 percent
01
02
03
04
05
06
0P
erc
en
t
0 20 40 60 80 100CNA
Median is 11 percent
Note: left percent=(number FT workers who left + .5*number PT workers who left)/number of FTEs
Figure 5: Percent of Workers Leaving in Past 3 Months
01
02
03
04
05
06
0P
erc
en
t
0 20 40 60 80 100RN
Median is 0 percent
01
02
03
04
05
06
0P
erc
en
t
0 20 40 60 80 100LPN
Median is 1 percent
01
02
03
04
05
06
0P
erc
en
t
0 20 40 60 80 100CNA
Median is 3 percent
Figure 6: Percent of FTE Positions Vacant
05
10
15
20
25
30
Pe
rce
nt
0 20 40 60 80 100RN
Median is 75 percent
05
10
15
20
25
30
Pe
rce
nt
0 20 40 60 80 100LPN
Median is 75 percent
05
10
15
20
25
30
Pe
rce
nt
0 20 40 60 80 100CNA
Median is 66 percent
Figure 7: Percent with at Least One Year of Job Tenure
Turnover Analysis of NNHSTurnover Analysis of NNHS
Compensation:Compensation: RNRN LPNLPN CNACNA
Starting WageStarting Wage
Health InsuranceHealth Insurance
PensionPension -- -- --
Working Conditions:Working Conditions:
Percent Working Over TimePercent Working Over Time ++ ++ ++
Controls include age and controls for patient's mental and physical Controls include age and controls for patient's mental and physical health, length of stay, payment type, and per diem rate.health, length of stay, payment type, and per diem rate.
Staff Turnover by Resident RaceStaff Turnover by Resident RaceWOMENWOMEN
Sample SizesSample Sizes No No ControlsControls
ControlsControls
White White BlackBlack WhiteWhite BlackBlack DiffDiff DiffDiff
Percent of Staff Leaving in Last Three MonthsPercent of Staff Leaving in Last Three Months
Controls include age and controls for patient's mental and physical Controls include age and controls for patient's mental and physical health, length of stay, payment type, and per diem rate.health, length of stay, payment type, and per diem rate.
Staff Turnover by Resident RaceStaff Turnover by Resident RaceMENMEN
Sample SizesSample Sizes No No ControlsControls
ControlsControls
White White BlackBlack WhiteWhite BlackBlack DiffDiff DiffDiff
Percent of Staff Leaving in Last Three MonthsPercent of Staff Leaving in Last Three Months
Controls include age and controls for patient's mental and physical Controls include age and controls for patient's mental and physical health, length of stay, payment type, and per diem rate.health, length of stay, payment type, and per diem rate.
ConclusionsConclusions•Turnover is a significant problem for nursing Turnover is a significant problem for nursing homes.homes.
• Working conditions and compensation affect Working conditions and compensation affect level of turnoverlevel of turnover
• Little evidence that facility type (size, case Little evidence that facility type (size, case mix) affects turnovermix) affects turnover
•Significant racial differences in the age, health, Significant racial differences in the age, health, and payments methods for nursing home and payments methods for nursing home residentsresidents
• Despite these differences, there are only Despite these differences, there are only modest racial differences in resident exposure modest racial differences in resident exposure to turnover.to turnover.
AppendixAppendix
Turnover analysis of NNASTurnover analysis of NNASVariableVariable Likely Leave Likely Leave
Job Next Job Next YearYear
Looking for Looking for Different JobDifferent Job
How Much How Much Turnover?Turnover?
How Much How Much Interfere?Interfere?
AgeAge -0.0108-0.0108 0.00500.0050
(1.41)(1.41) (0.63)(0.63)
Age^2/100Age^2/100 0.01050.0105 -0.0103-0.0103
(1.10)(1.10) (1.04)(1.04)
FemaleFemale -0.0549-0.0549 -0.1501-0.1501
(1.18)(1.18) (3.27)(3.27)
HispanicHispanic -0.1438-0.1438 -0.1824-0.1824
(2.18)(2.18) (2.61)(2.61)
BlackBlack 0.04830.0483 0.04320.0432
(1.45)(1.45) (1.38)(1.38)
AsianAsian 0.01080.0108 0.02070.0207
(0.13)(0.13) (0.24)(0.24)
Years of SchoolingYears of Schooling 0.01390.0139 0.01310.0131
(1.61)(1.61) (1.57)(1.57)
English Main English Main LanguageLanguage
-0.0957-0.0957 -0.1266-0.1266
(1.39)(1.39) (1.77)(1.77)
Spanish Main Spanish Main LanguageLanguage
0.09350.0935 0.06110.0611
(0.83)(0.83) (0.56)(0.56)
Turnover analysis of NNASTurnover analysis of NNASVariableVariable Likely Leave Likely Leave
Job Next Job Next YearYear
Looking for Looking for Different JobDifferent Job
How Much How Much Turnover?Turnover?
How Much How Much Interfere?Interfere?
U.S. CitizenU.S. Citizen -0.0382-0.0382 0.07280.0728
(0.57)(0.57) (1.18)(1.18)
MarriedMarried 0.00330.0033 0.02630.0263
(0.09)(0.09) (0.77)(0.77)
Divorced or SeparatedDivorced or Separated 0.09960.0996 0.14970.1497
(2.58)(2.58) (3.92)(3.92)
Receive Job Training Before Receive Job Training Before 19871987