Iowa nursing home staff turnover climbs; state program still unfunded

Clark Kauffman is deputy editor at Iowa Capital Dispatch, where this article first appeared.

A new state report on staffing in Iowa nursing homes indicates employee turnover rates are continuing to climb 15 years after state lawmakers approved, but failed to fund, a program to address the issue.

The 2024 Nursing Facility Turnover Report from the Iowa Department of Health and Human Services indicates that between 2022 and 2023, the average rate of turnover among registered nurses working in nursing homes increased from 52 percent to 66 percent. Among licensed practical nurses, turnover increased from 53 percent to 68 percent.

Among certified nurse aides, who provide much of the hands-on care in Iowa nursing homes, the average turnover rate increased from 72 percent to 77 percent.

Turnover rates reflect the percentage of workers who left their job during the course of a year. If a nursing home had nine aides on staff and seven of them left during the year, the turnover rate would be just under 78 percent. If eighteen aides vacated those nine positions during the year, the turnover rate would be 200 percent.

The federal Centers for Medicare and Medicaid Services considers high staff turnover to be a major contributor to lesser quality care, in part because newly hired or temp-agency nurses and aides don’t know the residents and their needs.

WHERE STAFF TURNOVER IS HIGHEST

According to the report, the Iowa home with the highest turnover rate among caregivers in 2023 was Northbrook Healthcare and Rehabilitation Center, formerly Northbrook Manor, in Cedar Rapids. The home saw a 612 percent turnover among its certified nursing assistants (CNAs), a 667 percent turnover among licensed practical nurses (LPNs), and a 720 percent turnover in registered nurses.

In the position of administrator, there was a 300 percent turnover at Northbrook, indicating three different administrators left the facility over the course of just one year.

Some of the Iowa nursing home chains that have been cited for significant regulatory violations are also among those with the highest reported turnover. For example, homes that are part of the Aspire chain are run by a Florida for-profit company called Beacon Health Management that saw two of its Iowa facilities closed by the state in 2024. Three of the chain’s homes reported turnover rates of 300 percent or more in 2023:

  • Aspire of Washington — Registered nurses, 436 percent. LPNs, 436 percent. CNAs, 65 percent. Administrator: 277 percent.
  • Aspire of Donnellson: Registered nurses, 300 percent. LPNs, 382 percent. CNAs, 393 percent. Administrator, 200 percent.
  • Aspire of Sutherland — Registered nurses, 300 percent. LPNs, 200 percent. CNAs, 224 percent. Administrator, 171 percent.

On the other end of the spectrum, fourteen of the sixteen Iowa nursing homes run by the nonprofit Good Samaritan Society reported no turnover whatsoever among all of their nurses and CNAs, according to the new report.

The Iowa homes with the highest turnover among all caregiving staff were:

  • Northbrook Healthcare and Rehabilitation Center (formerly Northbrook Manor) in Cedar Rapids, at 634 percent. The home is run by Erez Healthcare Group.
  • On With Life in Ankeny, at 591 percent. The home is run by On With Life Inc.
  • Aspire of Donnellson, at 381 percent. The home is run by Beacon Health Management.
  • Montezuma Specialty Care, at 263 percent. The home is run by Care Initiatives, which had five other facilities among the 20 Iowa homes with the highest caregiver turnover.
  • Arbor Court in Mount Pleasant, at 232 percent. The home is run by Midwest Geriatrics.
  • Regency Care Center in Norwalk, at 227 percent. The home is run by Midwest Geriatrics.
  • Aspire of Sutherland, at 224 percent. The home is run by Beacon Health Management.
  • Azria Health Park Place in Des Moines, at 213 percent. The home is run by Azria Health.
  • Greater Southside Health and Rehabilitation Center (formerly known as Genesis Senior Living) in Des Moines, at 213 percent. The home is run by Midwest Geriatrics.
  • Bettendorf Health Care Center, at 211 percent. The home is run by Midwest Geriatrics.
  • Parkview Manor in Wellman, at 211 percent. The home is run by Midwest Geriatrics.

According to the Department of Health and Human Services, the state-run Iowa Veterans Home did not report employee retention data to Iowa Medicaid for 2023, and so it was excluded from the statewide report on turnover.

LAWMAKERS FAILED TO FUND PROGRAM

The state agency’s report suggests the turnover rate in Iowa nursing homes continues to outpace that of many other states. In 2022, the Long-Term Care Community Coalition reported that nationally, the average nursing home had an annual turnover rate of 53.3 percent among nursing staff.

A separate set of data published by the Centers for Medicare and Medicaid Services indicates that in fiscal year 2023, 14 percent of Iowa’s 422 nursing facilities were cited for insufficient staffing. That was more than double the national average, which was 5.9 percent.

Only five other states — Hawaii, Michigan, Montana, New Mexico and Oregon — had a worse record of compliance with new federal staffing requirements. Iowa’s neighboring states of Nebraska, South Dakota, Wisconsin and Missouri had no more than 2 percent to 6.8 percent of their facilities cited for insufficient staffing in 2023.

The Health and Human Services report on turnover in Iowa nursing homes grew out of legislation that was approved in 2009, when state lawmakers instructed the agency to implement a program for recognizing Iowa nursing facilities that had improved residents’ quality of life by successfully meeting certain benchmarks. The program, which lawmakers dubbed “Pay for Performance,” was to take into account employee turnover.

But as the agency points out in its latest report, lawmakers provided no funding for the program when it launched in 2010, and it has not funded it at any time since then — although the data on staff turnover is still being collected, compiled and sent to lawmakers each year. Due to the lack of funding, the report says, agency staff have not analyzed the data.

Senate President Amy Sinclair, a Republican from Allerton who accepted $22,000 from the Iowa nursing home industry’s primary political action committee during the past 26 months, recently told Iowa Public Radio she doesn’t anticipate there will be any Government Oversight Committee hearings this year on nursing homes or the state’s oversight of the industry.

“Nursing homes are the most highly regulated industry in the state of Iowa, from the federal government to the state government,” Sinclair said. She added,

Do bad things happen? Sure. They also happen in every other sector of public service, whether that’s just in a hospital, or whether that’s in our law enforcement, or whether that’s in a public school. Bad things do tend to happen. We have in place mechanisms for overseeing those. We don’t need to just have a legislative public spectacle to talk about things that are already being overseen by the appropriate agencies and are being well overseen by those appropriate agencies.

About the Author(s)

Clark Kauffman

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