The Best Nursing Home Quality Measure CMS Does Not Publish – Turnover

March 3rd, 2014 by Rod Baird

A recent Journal of the American Medical Directors Association (JAMDA) article prompted this question: Are Nursing Home Survey Deficiencies Higher in Facilities With Greater Staff Turnover?  (Published February 2014).

When you have to personally recommend a nursing home, how do you pick from the myriad of facilities in your region?  Sad to say, I do not look at Nursing Home Compare or other widely available measures. I’ve worked in LTPAC since 1977 – sometimes it’s impossible to avoid becoming a surrogate decision maker for friends when someone they care for is facing Nursing Home Placement. (e.g. Where should I place my mother?) When I have to become a surrogate – here are the ‘quality issues’ I’ll focus on to make that recommendation.  Of course, that is after filtering by selection factors such as  personal finances and specialty needs:

1. What location will permit the highest number of actual family visits?  Family and friends visiting is the best way to get quality care.  Almost any facility will step-up their game if friends/family are involved (preferably daily – if just for 10-20 minutes).  There are great facilities and terrible facilities, but the vast majority fall in the middle; they do a good job with limited resources.  Patients with high frequency family involvement will get more care.  If you make a mistake and pick the wrong location – you’ll know it first-hand.  There is no substitute for direct observation.

2. Administrative Turnover:  When visit frequency is not a variable based on facility location, I then look at turnover. Simply because of my role, I usually know how to find a facility’s Administrative Turnover. Of the available facilities, which has the most tenured leadership (administrator, Exec Dir, etc.)?  Once they pass 5 years tenure, I stop counting.  Stability at the top is the easiest way to correlate the relative quality of the organization.

Reading that JAMDA article was a comfort – seeing some scientific proof that turnover was directly linked to quality.  Wonder when CMS will begin publishing this data; it’s in their files?


Rod Baird

About Rod Baird

Rod Baird is the Founder and President of Geriatric Practice Management (GPM). Since 1977, he’s led provider and management organizations that deliver care to Medicare/Medicaid beneficiaries. Past programs he’s overseen include home health, personal care, hospice, rehabilitation hospitals, adult and psych daycare, alcohol/drug rehabilitation, industrial medicine and primary care practices. The Centers for Medicare and Medicaid Services (CMS) selected Baird as one of only 73 individuals to serve with its InnovationProgram. His educational background includes a Master’s Degree in Physical Chemistry from the American University, Washington, D.C.

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