Understanding the predictors of direct-care worker turnover rates in nursing homes has received considerable attention. Yet, much less is known about retention rates for direct care workers. Turnover and retention are critical aspects of facilities’ ability to provide cost-effective, high quality, person-centered care. Facilities operate in an environment necessitating constant recruitment, training, and retention efforts to maintain adequate staffing. Our study examines facility-level factors associated with the retention and turnover rates of State-Tested Nurse Aides (STNAs) using data from the 2015 Ohio Biennial Survey of Long-Term Care (response rate = 93.6%; N=898), Medicaid Cost Reports and Nursing Home Compare. We find the mean retention rate for STNAs was 63.9% (s=18.4), the mean turnover rate was 53.9% (s=28.0), and there was a statistically significant negative correlation between STNA retention and turnover (r=-.284). We describe how characteristics, both modifiable and not modifiable at the facility level, affect turnover and retention rates using multiple regression analysis. Facility modifiable characteristics include wage rate, administrator tenure, RN/LPN turnover/retention rates, staffing hours per resident, special unit staffing patterns, culture change, and person-centered care. Non-modifiable characteristics include Medicaid per diem rate, percentage of Medicare residents, facility ownership, facility size, region, occupancy rate, and chain affiliation. Our study compares if the factors that improve turnover also improve retention and provides recommendations about modifiable factors related to direct care worker retention and turnover rates.
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