DOES HIGHER WORKER RETENTION BUFFER AGAINST CONSUMER COMPLAINTS? EVIDENCE FROM OHIO NURSING HOMES

Abstract

Abstract 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 with complete data (n = 691). Core variables came from the 2017 Ohio Biennial Survey of Long-term Care Facilities and CMS Automated Survey Processing Environment Complaints/Incidents Tracking System. Four quartiles were created to compare NHs on their CNA retention rates: 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 counts of allegations and complaints. All regressions controlled for facility and county-level factors and clustered facilities by county. Controlling for other factors, 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 difference between high and low retention on total allegations, substantiated allegations, 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 controlling for other variables. Research, policy, and practice efforts are critical to increase CNA retention for better consumer experiences by substantively improving CNA job quality through career advancement, high wages, and benefits. Given some turnover is desirable, effective strategies for recruitment are also needed.