The Complexities of Measuring Worker Turnover in Long-Term Care

By Richard Shank

Researchers with the Better Jobs Better Care (BJBC) Demonstration Project recently published a paper in the latest issue of The Gerontologist that reflected on lessons learned during the demonstration regarding staff turnover rates. The primary concern is the lack of a uniform method to measure staff turnover since this variability leads to uncertainty in the ways staff turnover rates are currently interpreted.

Managing staff turnover among direct-care workers is a continual challenge for long-term care organizations—it is an ongoing target of reform efforts by both policy makers and care providers. The authors of this report suggested that more reliable and valid measures of staff turnover are needed in order to help guide staffing reform efforts.

These researchers first discovered problems with staff turnover measures when they began developing a tracking system. In the present study, they sought to illustrate ways to improve staff turnover measurements so that a workable tracking system could be developed. Their findings confirmed similar statements made by both academic researchers and the Government Accountability Office. Simply put, turnover rates are heavily affected by the components used to define the measure. Happy Nurse

Reported turnover rates vary widely across different types of long-term care providers and also by geographic region. Recent estimates vary widely state-by-state: nursing home turnover rates are estimated to be 25% in Hawaii and 117% in Wisconsin. The national average is thought to be about 78%. Similar rate variations are found in other areas of long-term care. Currently, it is impossible to tell whether these rate variations are caused by local labor market and workplace conditions or whether they stem from differing ways of defining the measures of staff turnover.

The generally accepted measure of turnover is a ratio of the number of separations (e.g., a voluntary or involuntary termination of employment) during a specific period of time to the total number of workers employed. However simple this definition seems, variations in the way organizations and states calculate separations and the unit of time (e.g. 6 months vs. 12 months) can impact the final calculation of the rate.

Many annual turnover rates reported in the past resulted from simply doubling a rate calculated from turnover data tracked for a period of 6 months. This method is imprecise because seasonal variability in employment often does not get reflected in the turnover data. The researchers recommended that data be monitored for the entire calendar year, as it would produce more precise annual turnover reports.

To avoid these inconsistencies, researchers at Penn State developed a management-information system (MIS) that is part of the broader BJBC initiative. The MIS is an Internet-based data system that explicitly defines and collects data elements used to calculate comparable turnover rates. The researchers argued that more meaningful management decisions can be made by creating a standardized set of measurements (of time and separations), as more accurate comparisons may be made both within and across long-term care organizations.

Policy makers, workforce analysts, and long-term care managers who need accurate comparative turnover information should be aware that current turnover data might be misleading. Steps are needed to ensure that a common definition of turnover and a standardized method of collecting information is used when attempting to compare turnover rates across organizations; otherwise, attempts at setting benchmarking goals may be based on misleading data and lead to inefficient workforce management decisions.

Source: Theresa Barry, Peter Kemper, and S. Diane Brannon. 2008. Measuring working turnover in long-term care: Lessons from the Better Jobs Better Care Demonstration. The Gerontologist 48: 394-400.

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