Fix nursing home staff turnover

Imagine you run a business or organization. You lose 40, 50 percent or more of your key staff every year. Will you succeed or fail?

The annual loss of staff - employee turnover - is the Achilles heel of the nursing home industry; damaging its ability to provide the consistent quality of care that should be expected.

Few people were aware of the alarming numbers until Erin Jordan and The Gazette gave visibility to them ('Keeping Caregivers”, Aug. 17). The Gazette's story provided the startling turnover numbers and pointed out the detrimental impact. High amounts of turnover, particularly among the front line certified nurse aide staff (a turnover average of 56 percent in the most recent report issued by state government), lead to worse outcomes for residents and an inefficient use of taxpayer and consumer dollars.

Worse outcomes. Poor use of dollars. These are things that cry out for attention.

Why does the problem exist? Largely because of the basic business model in use. Consistently successful businesses and organizations view and treat their staff as their most important asset - and invest heavily in recruiting the best and keeping the best.

Sadly, too many nursing homes have adopted the opposite model: making minimal investment in employees and accepting high rates of annual turnover. It's been based on the notion that someone can always be found to do the work. That model has led to a revolving door of workers due to inadequate training and compensation, limited career opportunities, too few co-workers to rely on, and too little respect for the work being performed. What can be done about it? Can improvements be made that will lead to reduced employee turnover, better quality of care, and better use of precious taxpayer and consumer dollars?

Yes they can, and I'll offer two recommendations:

First, there are all kinds of data collected by state government regarding nursing facilities - staffing levels, employee turnover, complaints received, results of inspections, money spent on staff training, use of temporary staff vs. permanent staff, etc. This data should be routinely analyzed to identify highly performing and poorly performing facilities. The facilities that are doing things right, those who make it a priority to take good care of their employees who, in turn, take good care of residents, should get particular attention. We can take what is learned about what these facilities are doing and how, and replicate their best practices elsewhere.

Second, start paying for the right things.

The government - the taxpayer - is a primary payer of nursing home care. Based on existing payment rules, the government is essentially saying this to nursing homes:

' Any level of turnover is OK. We will pay you for the expenses you incur for the loss of employees and the costs of hiring and training their replacements, and

' The quality of care and services you provide doesn't matter. We will pay you for the volume of care and services, not the quality.

The government should do what successful businesses do; focus on return on investment. It should change the rules and pay for the right things: low turnover of employees and high quality of care.

It costs money to hire and keep good people, but there is ample money in the system. It's just being spent on the wrong things.

The tens of millions of dollars annually spent on employee turnover should be redirected to invest in compensation, training, recognition and other things that will lead to lower employee turnover and better care for residents.

Enhancing the care of our family, friends and neighbors in nursing facilities should be one of the top priorities of state government. The Gazette, via its reporting on employee turnover, has created the opportunity for state government to make it so.

' John Hale is founder of The Hale Group. Comments: hale_johnd@msn.com.