Employee Turnover in the Long-Term Care Industry: 2004 NNAS and NNHS Data William Even Miami...

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

assistant = 4 months salary (Pillemer assistant = 4 months salary (Pillemer 1996)1996)

Turnover in LTCTurnover in LTC

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


05

10

15

20

25

30

Pe

rce

nt

0 20 40 60 80 100LPN


05

10

15

20

25

30

Pe

rce

nt

0 20 40 60 80 100CNA


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 ++ ++ ++

UnionUnion -- --

Facility Characteristics:Facility Characteristics:

Part of a ChainPart of a Chain ++

For Profit FacilityFor Profit Facility +/-+/-

Alzheimer's Beds Alzheimer's Beds

Turnover Analysis of NNHSTurnover Analysis of NNHS

Facility Characteristics:Facility Characteristics: RNRN LPNLPN CNACNA

Behavior Beds – Non Alzheimer’sBehavior Beds – Non Alzheimer’s

Rehabilitation BedsRehabilitation Beds

Number of BedsNumber of Beds ++ ++

Occupancy RateOccupancy Rate ++ --

Percent MedicarePercent Medicare

Percent MedicaidPercent Medicaid -- ++

Nursing Hours Per Patient Per DayNursing Hours Per Patient Per Day -- -- --

Does Facility Have a Waiting List?Does Facility Have a Waiting List?

Director Nursing TenureDirector Nursing Tenure -- -- --

Medical Director Tenure Medical Director Tenure

Racial Difference in Means for ResidentsRacial Difference in Means for Residents

Both SexesBoth Sexes

Sample SizeSample Size MeansMeans

White White BlackBlack WhiteWhite BlackBlack DiffDiff

AgeAge 12,10112,101 1,4061,406 81.281.2 74.974.9 6.3*6.3*

FemaleFemale 12,10112,101 1,4061,406 0.720.72 0.630.63 0.09*0.09*

Depressed MoodDepressed Mood 11,95811,958 1,3831,383 0.620.62 0.530.53 0.08*0.08*

Total ADLsTotal ADLs 12,01112,011 1,3911,391 4.064.06 4.164.16 -0.09-0.09

Restraints UsedRestraints Used 12,03712,037 1,3941,394 0.380.38 0.470.47 -0.08*-0.08*

Private Health Private Health InsuranceInsurance

11,55811,558 1,3251,325 0.120.12 0.060.06 0.06*0.06*

MedicaidMedicaid 11,55811,558 1,3251,325 0.340.34 0.560.56 -0.23*-0.23*

Racial Difference in Means for ResidentsRacial Difference in Means for ResidentsSample SizeSample Size MeansMeans

MENMEN

AgeAge 3,3553,355 513513 76.076.0 68.968.9 7.0*7.0*

Depressed MoodDepressed Mood 3,3023,302 508508 0.560.56 0.500.50 0.060.06

Total ADLsTotal ADLs 3,3223,322 508508 3.903.90 3.953.95 -0.06-0.06

Restraints UsedRestraints Used 3,3333,333 509509 0.370.37 0.460.46 -0.09*-0.09*

Private Health InsurancePrivate Health Insurance 3,1953,195 473473 0.120.12 0.060.06 0.06*0.06*

MedicaidMedicaid 3,1953,195 473473 0.330.33 0.550.55 -0.22*-0.22*

WOMENWOMEN

White White BlackBlack WhiteWhite BlackBlack DiffDiff

AgeAge 8,7468,746 893893 83.283.2 78.378.3 4.9*4.9*

Depressed MoodDepressed Mood 8,6568,656 875875 0.640.64 0.550.55 0.08*0.08*

Total ADLsTotal ADLs 8,6898,689 883883 4.124.12 4.274.27 -0.15*-0.15*

Restraints UsedRestraints Used 8,7048,704 885885 0.390.39 0.470.47 -0.08*-0.08*

Private Health InsurancePrivate Health Insurance 8,3638,363 852852 0.120.12 0.060.06 0.06*0.06*

MedicaidMedicaid 8,3638,363 852852 0.340.34 0.570.57 -0.23*-0.23*

Staff Turnover by Resident RaceStaff Turnover by Resident RaceBOTH SEXESBOTH SEXES

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

RNsRNs 1104611046 12331233 13.1%13.1% 15.9%15.9% -2.8%-2.8% -1.8%-1.8%

LPNsLPNs 1091610916 12081208 11.7%11.7% 13.5%13.5% -1.8%-1.8% -1.6%-1.6%

CNAsCNAs 1082910829 11791179 16.8%16.8% 15.5%15.5% 1.4%1.4% 2.2%2.2%

Vacancies as a Percent of FTEsVacancies as a Percent of FTEs

RNsRNs 1103111031 12481248 11.9%11.9% 10.5%10.5% 1.4%1.4% 2.4%2.4%

LPNsLPNs 1089610896 12281228 9.7%9.7% 7.3%7.3% 2.3%*2.3%* 2.7%*2.7%*

CNAsCNAs 1084310843 12011201 6.4%6.4% 4.7%4.7% 1.7%*1.7%* 1.7%*1.7%*

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


ControlsControls



RNsRNs 80278027 798798 12.9%12.9% 14.5%14.5% -1.7%-1.7% -2.4%-2.4%

LPNsLPNs 79287928 780780 11.8%11.8% 13.3%13.3% -1.5%-1.5% -1.6%-1.6%

CNAsCNAs 78627862 765765 16.4%16.4% 15.0%15.0% 1.5%1.5% 1.9%1.9%


RNsRNs 80148014 801801 11.8%11.8% 10.3%10.3% 1.5%1.5% 2.4%2.4%

LPNsLPNs 79117911 787787 9.8%9.8% 7.4%7.4% 2.4%*2.4%* 2.7%*2.7%*

CNAsCNAs 78737873 773773 6.3%6.3% 4.8%4.8% 1.5%*1.5%* 1.4%*1.4%*


Staff Turnover by Resident RaceStaff Turnover by Resident RaceMENMEN


ControlsControls



RNsRNs 30193019 435435 13.9%13.9% 18.4%18.4% -4.5%-4.5% -0.5%-0.5%

LPNsLPNs 29882988 428428 11.3%11.3% 13.9%13.9% -2.6%-2.6% -1.5%-1.5%

CNAsCNAs 29672967 414414 17.9%17.9% 16.4%16.4% 1.5%1.5% 2.5%2.5%


RNsRNs 30173017 447447 12.3%12.3% 10.9%10.9% 1.4%1.4% 2.2%2.2%

LPNsLPNs 29852985 441441 9.5%9.5% 7.3%7.3% 2.2%*2.2%* 2.6%*2.6%*

CNAsCNAs 29702970 428428 6.7%6.7% 4.5%4.5% 2.2%*2.2%* 2.2%*2.2%*


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)






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

0.00420.0042 -0.0134-0.0134 0.03430.0343 0.05030.0503

(0.11)(0.11) (0.35)(0.35) (1.01)(1.01) (0.05)(0.05)

Employer Paid All Training Employer Paid All Training CostsCosts

-0.0437-0.0437 -0.0446-0.0446 0.02470.0247 -0.0199-0.0199

(1.25)(1.25) (1.29)(1.29) (0.92)(0.92) (0.02)(0.02)

Employer Paid for Some Employer Paid for Some TrainingTraining

0.01860.0186 0.03060.0306 0.03980.0398 -0.0932-0.0932

(0.33)(0.33) (0.56)(0.56) (0.89)(0.89) (0.09)(0.09)

Trained in Nursing FacilityTrained in Nursing Facility 0.02930.0293 0.03700.0370 0.00540.0054 0.05180.0518

(0.82)(0.82) (1.04)(1.04) (0.19)(0.19) (0.05)(0.05)

Trained in Community Trained in Community CollegeCollege

0.00530.0053 0.02040.0204 0.00210.0021 0.07470.0747

(0.13)(0.13) (0.51)(0.51) (0.06)(0.06) (0.07)(0.07)

Ln (hourly wage)Ln (hourly wage) -0.1659-0.1659 -0.1112-0.1112 -0.1609-0.1609 -0.1865-0.1865

(2.31)(2.31) (1.49)(1.49) (2.12)(2.12) (0.19)(0.19)






Pension PlanPension Plan -0.0387-0.0387 -0.0234-0.0234 -0.0503-0.0503 -0.0021-0.0021

(1.27)(1.27) (0.81)(0.81) (1.62)(1.62) (0.00)(0.00)

In Health Insurance PlanIn Health Insurance Plan -0.0357-0.0357 -0.0439-0.0439 -0.0182-0.0182 -0.0465-0.0465

(1.42)(1.42) (1.59)(1.59) (0.76)(0.76) (0.05)(0.05)

Job tenure (in months )Job tenure (in months ) -0.0015-0.0015 -0.0005-0.0005 0.00060.0006 0.00040.0004

(2.61)(2.61) (0.93)(0.93) (1.34)(1.34) (0.00)(0.00)

Job Tenure^2/100Job Tenure^2/100 0.00030.0003 -0.0001-0.0001 -0.0001-0.0001 0.00000.0000

(1.52)(1.52) (0.34)(0.34) (0.51)(0.51) (0.00)(0.00)

Work Mandatory OvertimeWork Mandatory Overtime 0.08760.0876 0.06780.0678 0.11100.1110 0.21020.2102

(2.51)(2.51) (2.06)(2.06) (3.56)(3.56) (0.21)(0.21)

Desire to Work More HoursDesire to Work More Hours 0.02850.0285 0.07240.0724 0.00600.0060 -0.0780-0.0780

(0.80)(0.80) (2.01)(2.01) (0.19)(0.19) (0.08)(0.08)

Desire to Work Fewer HoursDesire to Work Fewer Hours 0.26570.2657 0.31010.3101 0.10110.1011 0.13380.1338

(6.01)(6.01) (7.17)(7.17) (1.98)(1.98) (0.13)(0.13)

# times injured at facility# times injured at facility -0.0006-0.0006 0.00060.0006 0.00440.0044 0.01010.0101

(0.37)(0.37) (0.36)(0.36) (1.51)(1.51) (0.01)(0.01)

Time off for good workTime off for good work -0.0318-0.0318 -0.0032-0.0032 -0.1053-0.1053 -0.0962-0.0962

(0.56)(0.56) (0.06)(0.06) (3.03)(3.03) (0.10)(0.10)




How How Much Much TurnoverTurnover??


BonusesBonuses -0.0396-0.0396 -0.0668-0.0668 0.01700.0170 0.01810.0181

(1.27)(1.27) (2.14)(2.14) (0.66)(0.66) (0.02)(0.02)

Facility Part of a ChainFacility Part of a Chain -0.0118-0.0118 -0.0353-0.0353 -0.0322-0.0322 0.01460.0146

(0.41)(0.41) (1.26)(1.26) (1.13)(1.13) (0.01)(0.01)

For Profit FacilityFor Profit Facility 0.05940.0594 0.04400.0440 -0.0097-0.0097 0.02640.0264

(1.80)(1.80) (1.46)(1.46) (0.31)(0.31) (0.03)(0.03)

Clusters of Beds for Clusters of Beds for AlzheimersAlzheimers

-0.0273-0.0273 0.01760.0176 0.11540.1154 0.07160.0716

and Related Dementiasand Related Dementias (0.86)(0.86) (0.62)(0.62) (3.71)(3.71) (0.07)(0.07)

Cluster of Beds for Behavior Cluster of Beds for Behavior UnitUnit

0.04300.0430 0.02100.0210 -0.0015-0.0015 -0.0308-0.0308

(Non-Alzheimers)(Non-Alzheimers) (0.57)(0.57) (0.32)(0.32) (0.02)(0.02) (0.03)(0.03)

Cluster of Beds for Cluster of Beds for RehabilitationRehabilitation

0.02490.0249 0.03070.0307 -0.0590-0.0590 -0.0392-0.0392

(0.51)(0.51) (0.73)(0.73) (1.36)(1.36) (0.04)(0.04)

Number of BedsNumber of Beds -0.0003-0.0003 -0.0001-0.0001 0.00000.0000 -0.0002-0.0002

(1.40)(1.40) (0.68)(0.68) (0.14)(0.14) (0.00)(0.00)

Occupancy RateOccupancy Rate -0.0131-0.0131 0.05420.0542 0.11110.1111 -0.1316-0.1316

(0.10)(0.10) (0.45)(0.45) (0.82)(0.82) (0.13)(0.13)



Looking for Looking for Different Different JobJob


How How Much Much InterfereInterfere??

Percent of Patients on Percent of Patients on MedicareMedicare

-0.0293-0.0293 0.22730.2273 -0.0293-0.0293 -0.2456-0.2456

(0.20)(0.20) (1.88)(1.88) (0.28)(0.28) (0.25)(0.25)

Percent of Patients on Percent of Patients on MedicaidMedicaid

-0.1250-0.1250 -0.0389-0.0389 0.03490.0349 -0.0676-0.0676

(1.5)(1.5) (0.57)(0.57) (0.44)(0.44) (0.07)(0.07)

Does Facility Have Waiting Does Facility Have Waiting ListList

0.04170.0417 0.03540.0354 -0.0480-0.0480 -0.0129-0.0129

(1.31)(1.31) (1.16)(1.16) (1.52)(1.52) (0.01)(0.01)

Director Nursing TenureDirector Nursing Tenure 0.00140.0014 0.00090.0009 -0.0052-0.0052 -0.0032-0.0032

(0.60)(0.60) (0.44)(0.44) (2.40)(2.40) (0.00)(0.00)

Medical Director TenureMedical Director Tenure -0.0001-0.0001 -0.0008-0.0008 -0.0017-0.0017 -0.0002-0.0002

(0.05)(0.05) (0.42)(0.42) (0.80)(0.80) (0.00)(0.00)

Percent UnionPercent Union 0.02020.0202 0.00780.0078 0.02550.0255 -0.0148-0.0148

(1.11)(1.11) (0.38)(0.38) (1.01)(1.01) (0.01)(0.01)

Nursing Hours Per Patient Per Nursing Hours Per Patient Per DayDay

-0.0126-0.0126 -0.0202-0.0202 -0.0050-0.0050 -0.0110-0.0110

(2.69)(2.69) (4.03)(4.03) (1.22)(1.22) (0.01)(0.01)

ObsObs 1,5651,565 1,5651,565 1,5701,570 1,5701,570

Turnover analysis of NNHS: RNSTurnover analysis of NNHS: RNSVariableVariable %Left%Left %Vacancy%Vacancy % %

Tenure>1Tenure>1

Starting WageStarting Wage 0.0003210.000321 0.001260.00126 -0.0624-0.0624

(0.14)(0.14) (0.82)(0.82) (-0.22)(-0.22)

Health InsuranceHealth Insurance 0.03940.0394 0.02110.0211 7.0597.059

(1.30)(1.30) (0.86)(0.86) (1.30)(1.30)

PensionPension -0.0189-0.0189 0.0009880.000988 9.480***9.480***

(-1.03)(-1.03) (0.075)(0.075) (3.53)(3.53)

% Working over time% Working over time 0.05620.0562 0.0874***0.0874*** -2.009-2.009

(1.56)(1.56) (3.95)(3.95) (-0.46)(-0.46)

UnionUnion 0.01770.0177 -0.00269-0.00269 5.4005.400

(0.68)(0.68) (-0.15)(-0.15) (1.22)(1.22)

Facility Part of a ChainFacility Part of a Chain 0.0299*0.0299* -0.00954-0.00954 -8.156***-8.156***

(1.65)(1.65) (-0.67)(-0.67) (-2.95)(-2.95)

For Profit FacilityFor Profit Facility -0.00149-0.00149 -0.00777-0.00777 -1.418-1.418

(-0.084)(-0.084) (-0.49)(-0.49) (-0.49)(-0.49)

Clusters of Beds for AlzheimersClusters of Beds for Alzheimers 0.005040.00504 -0.0116-0.0116 -1.779-1.779

(0.29)(0.29) (-0.87)(-0.87) (-0.65)(-0.65)

Clusters of Beds for BehaviorClusters of Beds for Behavior 0.04000.0400 0.01350.0135 1.4341.434

(0.62)(0.62) (0.46)(0.46) (0.20)(0.20)


Tenure>1Tenure>1

Cluster of Beds for RehabilitationCluster of Beds for Rehabilitation 0.008250.00825 0.0342*0.0342* -2.839-2.839

(0.39)(0.39) (1.92)(1.92) (-0.77)(-0.77)

# Beds:# Beds:

50-9950-99 0.0712**0.0712** -0.0185-0.0185 -5.527-5.527

(1.97)(1.97) (-0.72)(-0.72) (-1.29)(-1.29)

100-199100-199 0.111***0.111*** -0.00849-0.00849 -8.637**-8.637**

(3.06)(3.06) (-0.33)(-0.33) (-1.97)(-1.97)

200+200+ 0.180**0.180** 0.02800.0280 0.1090.109

(2.06)(2.06) (0.85)(0.85) (0.020)(0.020)

Occupancy Rate:Occupancy Rate:

70-7970-79 -0.00628-0.00628 0.007730.00773 9.953*9.953*

(-0.16)(-0.16) (0.24)(0.24) (1.80)(1.80)

80-8980-89 -0.0226-0.0226 0.03100.0310 14.47***14.47***

(-0.74)(-0.74) (1.20)(1.20) (3.19)(3.19)

90-9490-94 -0.0256-0.0256 -0.0000422-0.0000422 8.800*8.800*

(-0.76)(-0.76) (-0.0017)(-0.0017) (1.90)(1.90)

95+95+ -0.0589*-0.0589* -0.000397-0.000397 14.61***14.61***

(-1.94)(-1.94) (-0.017)(-0.017) (3.22)(3.22)

Turnover analysis of NNHS: RNSTurnover analysis of NNHS: RNS

VariableVariable %Left%Left %Vacancy%Vacancy % % Tenure>1Tenure>1

Percent on Medicare:Percent on Medicare:

10-1910-19 0.004480.00448 0.007640.00764 -2.537-2.537

(0.23)(0.23) (0.52)(0.52) (-0.88)(-0.88)

20+20+ 0.009300.00930 0.01090.0109 -3.150-3.150

(0.37)(0.37) (0.54)(0.54) (-0.75)(-0.75)

Percent on Medicaid:Percent on Medicaid:

20-3920-39 -0.0546*-0.0546* 0.01300.0130 -2.733-2.733

(-1.90)(-1.90) (0.40)(0.40) (-0.43)(-0.43)

40-5940-59 -0.0337-0.0337 0.02520.0252 -4.064-4.064

(-1.12)(-1.12) (0.86)(0.86) (-0.72)(-0.72)

60-7960-79 -0.0659**-0.0659** 0.02490.0249 -4.649-4.649

(-2.12)(-2.12) (0.89)(0.89) (-0.83)(-0.83)

80+80+ -0.0807***-0.0807*** 0.004190.00419 -2.211-2.211

(-2.59)(-2.59) (0.13)(0.13) (-0.35)(-0.35)


Tenure>1Tenure>1

Nursing Hours Per Patient Per Day:Nursing Hours Per Patient Per Day:

2-2.992-2.99 -0.157***-0.157*** -0.0658**-0.0658** 23.73***23.73***

(-3.18)(-3.18) (-2.15)(-2.15) (3.78)(3.78)

3-3.993-3.99 -0.126***-0.126*** -0.0507*-0.0507* 18.88***18.88***

(-2.76)(-2.76) (-1.68)(-1.68) (3.03)(3.03)

4-4.994-4.99 -0.0944***-0.0944*** -0.0606**-0.0606** 19.18**19.18**

(-2.85)(-2.85) (-2.45)(-2.45) (2.49)(2.49)

5-11.995-11.99 -0.127***-0.127*** -0.0449-0.0449 21.54***21.54***

(-4.72)(-4.72) (-1.57)(-1.57) (2.73)(2.73)

12+12+ -0.118***-0.118*** -0.0636***-0.0636*** 25.44***25.44***

(-4.47)(-4.47) (-2.81)(-2.81) (3.11)(3.11)

Does Facility Have Waiting ListDoes Facility Have Waiting List 0.006140.00614 -0.0256*-0.0256* -2.937-2.937

(0.36)(0.36) (-1.88)(-1.88) (-1.10)(-1.10)

Director Nursing TenureDirector Nursing Tenure -0.00803***-0.00803*** -0.00212-0.00212 2.640***2.640***

(-3.84)(-3.84) (-1.48)(-1.48) (9.36)(9.36)

Medical Director TenureMedical Director Tenure 0.00311*0.00311* 0.001550.00155 0.2650.265

(1.95)(1.95) (1.40)(1.40) (1.13)(1.13)

ObservationsObservations 909909 909909 908908

Turnover analysis of NNHS: LPNSTurnover analysis of NNHS: LPNSVariableVariable %Left%Left %Vacancy%Vacancy % %

Tenure>1Tenure>1

Starting WageStarting Wage 0.0008810.000881 -0.000195-0.000195 0.1480.148

(0.54)(0.54) (-0.13)(-0.13) (0.41)(0.41)

Health InsuranceHealth Insurance 0.02720.0272 0.02180.0218 3.4243.424

(1.44)(1.44) (1.29)(1.29) (0.87)(0.87)

PensionPension -0.0324***-0.0324*** 0.001270.00127 4.159**4.159**

(-2.87)(-2.87) (0.13)(0.13) (2.03)(2.03)

% Working over time% Working over time 0.03340.0334 0.0795***0.0795*** -4.829-4.829

(1.64)(1.64) (5.35)(5.35) (-1.37)(-1.37)

UnionUnion -0.0258*-0.0258* 0.0333*0.0333* 6.834**6.834**

(-1.86)(-1.86) (1.84)(1.84) (1.98)(1.98)

Facility Part of a ChainFacility Part of a Chain 0.01310.0131 -0.0193*-0.0193* -4.205*-4.205*

(1.15)(1.15) (-1.81)(-1.81) (-1.89)(-1.89)

For Profit FacilityFor Profit Facility 0.007650.00765 -0.0215*-0.0215* -2.142-2.142

(0.66)(0.66) (-1.75)(-1.75) (-0.89)(-0.89)

Clusters of Beds for AlzheimersClusters of Beds for Alzheimers 0.01060.0106 0.005450.00545 -1.556-1.556

(1.00)(1.00) (0.53)(0.53) (-0.71)(-0.71)

Clusters of Beds for BehaviorClusters of Beds for Behavior 0.04340.0434 0.02500.0250 -7.241-7.241

(1.14)(1.14) (0.95)(0.95) (-1.61)(-1.61)


Tenure>1Tenure>1

Cluster of Beds for RehabilitationCluster of Beds for Rehabilitation 0.04340.0434 0.02500.0250 -7.241-7.241

(1.14)(1.14) (0.95)(0.95) (-1.61)(-1.61)

# Beds:# Beds: 0.004620.00462 0.02360.0236 -1.244-1.244

50-9950-99 (0.34)(0.34) (1.46)(1.46) (-0.38)(-0.38)

(1.97)(1.97) (-0.72)(-0.72) (-1.29)(-1.29)

100-199100-199 0.02820.0282 0.02250.0225 -8.277**-8.277**

(1.28)(1.28) (1.05)(1.05) (-2.18)(-2.18)

200+200+ 0.0622***0.0622*** 0.02050.0205 -12.73***-12.73***

(2.81)(2.81) (1.04)(1.04) (-3.42)(-3.42)

Occupancy Rate:Occupancy Rate: 0.0746**0.0746** 0.0471*0.0471* -5.641-5.641

70-7970-79 (2.39)(2.39) (1.67)(1.67) (-1.17)(-1.17)

(-0.16)(-0.16) (0.24)(0.24) (1.80)(1.80)

80-8980-89 0.001260.00126 -0.0201-0.0201 10.88**10.88**

(0.053)(0.053) (-1.06)(-1.06) (2.52)(2.52)

90-9490-94 -0.0118-0.0118 -0.0146-0.0146 6.1836.183

(-0.61)(-0.61) (-0.86)(-0.86) (1.61)(1.61)

95+95+ -0.0132-0.0132 -0.0239-0.0239 4.3464.346

(-0.66)(-0.66) (-1.37)(-1.37) (1.15)(1.15)

Turnover analysis of NNHS: LPNSTurnover analysis of NNHS: LPNS



10-1910-19 0.002320.00232 0.01300.0130 0.5640.564

(0.20)(0.20) (1.22)(1.22) (0.26)(0.26)

20+20+ 0.004000.00400 0.02350.0235 0.2450.245

(0.24)(0.24) (1.36)(1.36) (0.068)(0.068)


20-3920-39 0.01880.0188 0.01730.0173 -6.676-6.676

(0.75)(0.75) (0.62)(0.62) (-1.19)(-1.19)

40-5940-59 -0.00254-0.00254 0.03730.0373 -0.0350-0.0350

(-0.12)(-0.12) (1.45)(1.45) (-0.0074)(-0.0074)

60-7960-79 0.008630.00863 0.03170.0317 -3.303-3.303

(0.40)(0.40) (1.40)(1.40) (-0.69)(-0.69)

80+80+ 0.002460.00246 -0.00664-0.00664 0.09090.0909

(0.096)(0.096) (-0.30)(-0.30) (0.017)(0.017)


Tenure>1Tenure>1


2-2.992-2.99 -0.0612**-0.0612** -0.0364*-0.0364* 7.6657.665

(-2.08)(-2.08) (-1.75)(-1.75) (1.59)(1.59)

3-3.993-3.99 -0.0619**-0.0619** -0.0463**-0.0463** 6.9246.924

(-2.19)(-2.19) (-2.23)(-2.23) (1.44)(1.44)

4-4.994-4.99 -0.0490*-0.0490* -0.0675***-0.0675*** 4.5694.569

(-1.91)(-1.91) (-4.66)(-4.66) (0.77)(0.77)

5-11.995-11.99 -0.0916***-0.0916*** -0.0184-0.0184 4.9944.994

(-5.11)(-5.11) (-0.71)(-0.71) (0.83)(0.83)

12+12+ -0.0873***-0.0873*** -0.0428**-0.0428** 9.288*9.288*

(-5.41)(-5.41) (-2.55)(-2.55) (1.71)(1.71)

Does Facility Have Waiting ListDoes Facility Have Waiting List -0.00686-0.00686 -0.0113-0.0113 1.2011.201

(-0.54)(-0.54) (-1.04)(-1.04) (0.55)(0.55)

Director Nursing TenureDirector Nursing Tenure -0.00345***-0.00345*** -0.00163-0.00163 1.613***1.613***

(-2.93)(-2.93) (-1.58)(-1.58) (6.87)(6.87)

Medical Director TenureMedical Director Tenure -0.00178*-0.00178* -0.000746-0.000746 0.2700.270

(-1.82)(-1.82) (-0.85)(-0.85) (1.37)(1.37)


Turnover analysis of NNHS: CNASTurnover analysis of NNHS: CNASVariableVariable %Left%Left %Vacancy%Vacancy %Tenure>1%Tenure>1

Starting WageStarting Wage -0.00363-0.00363 -0.00175-0.00175 0.456*0.456*

(-1.59)(-1.59) (-1.43)(-1.43) (1.75)(1.75)

Health InsuranceHealth Insurance -0.0363-0.0363 -0.00238-0.00238 4.543*4.543*

(-1.43)(-1.43) (-0.25)(-0.25) (1.78)(1.78)

PensionPension -0.000902-0.000902 0.008170.00817 5.121***5.121***

(-0.073)(-0.073) (1.44)(1.44) (3.44)(3.44)

% Working over time% Working over time 0.0703**0.0703** 0.0612***0.0612*** -5.148*-5.148*

(2.19)(2.19) (4.76)(4.76) (-1.75)(-1.75)

UnionUnion -0.0412***-0.0412*** 0.008100.00810 4.343**4.343**

(-3.37)(-3.37) (0.97)(0.97) (2.02)(2.02)

Facility Part of a ChainFacility Part of a Chain 0.008260.00826 -0.000466-0.000466 -2.317-2.317

(0.74)(0.74) (-0.080)(-0.080) (-1.46)(-1.46)

For Profit FacilityFor Profit Facility 0.0327***0.0327*** -0.0155**-0.0155** -1.665-1.665

(2.96)(2.96) (-2.56)(-2.56) (-1.04)(-1.04)

Clusters of Beds for AlzheimersClusters of Beds for Alzheimers 0.0186*0.0186* 0.006470.00647 -2.734-2.734

(1.66)(1.66) (1.06)(1.06) (-1.64)(-1.64)

Clusters of Beds for BehaviorClusters of Beds for Behavior 0.1710.171 0.006330.00633 -8.843***-8.843***

(1.29)(1.29) (0.45)(0.45) (-2.84)(-2.84)


Cluster of Beds for RehabilitationCluster of Beds for Rehabilitation -0.0278*-0.0278* 0.009220.00922 0.1180.118

(-1.90)(-1.90) (1.02)(1.02) (0.046)(0.046)

# Beds:# Beds:

50-9950-99 0.0332*0.0332* -0.00555-0.00555 -0.481-0.481

(1.92)(1.92) (-0.58)(-0.58) (-0.20)(-0.20)

100-199100-199 0.0522***0.0522*** -0.0159-0.0159 -1.599-1.599

(3.00)(3.00) (-1.60)(-1.60) (-0.65)(-0.65)

200+200+ 0.03500.0350 -0.0137-0.0137 5.0645.064

(1.36)(1.36) (-1.01)(-1.01) (1.52)(1.52)

Occupancy Rate:Occupancy Rate:

70-7970-79 -0.0123-0.0123 0.008020.00802 6.964**6.964**

(-0.50)(-0.50) (0.61)(0.61) (2.15)(2.15)

80-8980-89 -0.0243-0.0243 0.001060.00106 3.9503.950

(-0.98)(-0.98) (0.097)(0.097) (1.34)(1.34)

90-9490-94 -0.0392*-0.0392* 0.005750.00575 6.052**6.052**

(-1.92)(-1.92) (0.52)(0.52) (2.06)(2.06)

95+95+ -0.0549***-0.0549*** -0.00587-0.00587 6.565**6.565**

(-2.59)(-2.59) (-0.54)(-0.54) (2.15)(2.15)

Turnover analysis of NNHS: CNASTurnover analysis of NNHS: CNAS



10-1910-19 0.0228*0.0228* -0.00236-0.00236 -0.256-0.256

(1.79)(1.79) (-0.38)(-0.38) (-0.16)(-0.16)

20+20+ -0.0000716-0.0000716 0.007460.00746 -2.702-2.702

(-0.0041)(-0.0041) (0.80)(0.80) (-1.01)(-1.01)


20-3920-39 0.02480.0248 0.01030.0103 -7.111*-7.111*

(1.09)(1.09) (0.81)(0.81) (-1.82)(-1.82)

40-5940-59 0.0467**0.0467** 0.0236**0.0236** -8.013***-8.013***

(1.99)(1.99) (2.02)(2.02) (-2.70)(-2.70)

60-7960-79 0.004030.00403 0.0241**0.0241** -8.346***-8.346***

(0.19)(0.19) (2.21)(2.21) (-2.90)(-2.90)

80+80+ -0.00863-0.00863 0.0008040.000804 -4.075-4.075

(-0.35)(-0.35) (0.066)(0.066) (-1.23)(-1.23)



2-2.992-2.99 -0.119**-0.119** -0.0410**-0.0410** 1.5581.558

(-2.18)(-2.18) (-2.27)(-2.27) (0.40)(0.40)

3-3.993-3.99 -0.115**-0.115** -0.0400**-0.0400** 1.9071.907

(-2.27)(-2.27) (-2.26)(-2.26) (0.49)(0.49)

4-4.994-4.99 -0.123***-0.123*** -0.0492***-0.0492*** 0.7800.780

(-3.32)(-3.32) (-4.41)(-4.41) (0.17)(0.17)

5-11.995-11.99 -0.139***-0.139*** -0.0337**-0.0337** 3.4533.453

(-3.86)(-3.86) (-2.07)(-2.07) (0.71)(0.71)

12+12+ -0.158***-0.158*** -0.0492***-0.0492*** 2.9812.981

(-6.07)(-6.07) (-4.89)(-4.89) (0.52)(0.52)

Does Facility Have Waiting ListDoes Facility Have Waiting List 0.01770.0177 -0.00141-0.00141 -2.241-2.241

(1.61)(1.61) (-0.23)(-0.23) (-1.33)(-1.33)

Director Nursing TenureDirector Nursing Tenure -0.00236**-0.00236** -0.00163***-0.00163*** 1.015***1.015***

(-2.06)(-2.06) (-2.65)(-2.65) (6.38)(6.38)

Medical Director TenureMedical Director Tenure -0.00110-0.00110 0.0006550.000655 0.1010.101

(-1.19)(-1.19) (1.17)(1.17) (0.75)(0.75)


Employee Turnover in the Long-Term Care Industry: 2004 NNAS and NNHS Data William Even Miami...

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Transcript of Employee Turnover in the Long-Term Care Industry: 2004 NNAS and NNHS Data William Even Miami...