Industry criticism has also focused on decades of ownership of nursing homes by private equity and other private investment firms, which prioritized profits for investors above the well-being of residents. These owners have long been accused of insufficiently staffing their facilities and underpaying workers.
Labor is one of the main expenses in the operation of a nursing home, Dr. Gandhi said. “It’s not a very high margin industry, in general,” he said. “Any facility trying to maximize profits is going to be thinking carefully about its staffing costs.”
Nursing home staffs have also shown resistance to getting vaccinated against the coronavirus, complicating efforts by public health officials and nursing homes to provide blanket immunization protection for an individual facility. If a nurse who was immunized leaves and is replaced, the facility will need to ensure the new employee is also vaccinated, especially given the reluctance of some workers to getting a coronavirus shot.
“Trying to do a one-shot vaccination push isn’t enough,” Dr. Gandhi said. “You need continued vaccination outreach.”
Registered nurses, who are the most skilled workers, had the highest rates of turnover, and turnover varied widely across facilities. Among the states with the highest rates were Oklahoma, Montana and Kansas. Facilities that had low-star ratings on Medicare’s website comparing nursing homes had the highest median turnover, and nursing homes with high ratings had the lowest turnover. Turnover was also higher at for-profit institutions, owned by chains and those serving Medicaid beneficiaries, according to the study.
Melissa Unger, the executive director at S.E.I.U. 503, an Oregon division of the Service Employees International Union, said nurses struggle to work at facilities with too few staff members to adequately care for the residents.