Does Higher Worker Retention Buffer Against Consumer Complaints? Evidence From Ohio Nursing Homes

Area of Science:

• Healthcare Quality
• Gerontology
• Nursing Home Administration

Background:

• Nursing home (NH) quality is often assessed through consumer complaints.
• Certified nursing assistant (CNA) annual retention rates are a key indicator of NH workforce stability.

Purpose of the Study:

• To investigate the relationship between CNA annual retention rates and consumer complaints in Ohio nursing homes.
• To determine if higher CNA retention is associated with lower NH quality complaints.

Main Methods:

• Utilized data from the 2017 Ohio Biennial Survey of Long-term Care Facilities and CMS complaint data.
• Categorized NHs into quartiles based on CNA retention rates (low to very high).
• Employed negative binomial regressions, controlling for facility and county-level factors.

Main Results:

• Nursing homes with high and very high CNA retention (top 50%) received significantly fewer allegations (19% reduction).
• A nonlinear pattern emerged, with high-retention NHs reporting the fewest allegations and complaints.
• Very high-retention NHs unexpectedly showed a slight increase in unsubstantiated allegations compared to high-retention NHs.

Conclusions:

• While improved CNA retention generally reduces complaints, an optimal retention level appears to exist.
• Strategies to enhance CNA retention, such as increased wages and career advancement, may reduce substantiated complaints.
• Further research is needed to understand the nuances of very high retention and unsubstantiated allegations.