Katherine A Kennedy, PhD, MSG, LNHA, John R Bowblis, PhD
Abstract
Background and Objectives
This study examined the relationship between nursing home (NH) quality using consumer complaints and certified nursing assistant (CNA) annual retention rates among Ohio freestanding NHs (n = 691).
Research Design and Methods
Core variables came from the 2017 Ohio Biennial Survey of Long-term Care Facilities and CMS Automated Survey Processing Environment Complaints/Incidents Tracking System. To compare NHs, four quartiles of CNA retention rates were created: low (0-48%), medium (49-60%), high (61-72%), and very high retention (73-100%). Negative binomial regressions were estimated on total, substantiated, and unsubstantiated allegations and complaints. All regressions controlled for facility and county-level factors and clustered facilities by county.
Results
NHs in the top 50% (high and very high) of retention received 1.92 fewer allegations than those in the bottom 50%, representing a 19% difference; this trend was significant and negative across all outcomes. Using quartiles revealed a non-linear pattern: high retention NHs received the fewest number of allegations and complaints. The differences between high and low retention on allegations, substantiated, and unsubstantied allegations were 33% (3.73 fewer), 34% (0.51 fewer), and 32% (3.12 fewer) respectively. Unexpectedly, very high retention NHs received more unsubstantiated allegations than high retention NHs.
Discussion and Implications
While higher retention should result in fewer complaints, our results indicate that some turnover may be desirable because the very high retention NHs performed slightly worse than those with high retention. Among the remaining facilities, fewer complaints may be achieved by improving CNA retention through higher wages, career advancement, and better training.