Is Nursing Home Turnover Putting Seniors at Risk?

A warning sent from the Texas Healthcare Association (THA) has many asking – “Is nursing home turnover in North Texas putting seniors at risk?” The high rate of turnover is being called a “staffing crisis” by the THA, and is causing concern over the safety and quality of care in many nursing homes across the state.

The issue of staffing and quality of care is certainly a concern across the state, which houses more than 92,000 nursing home residents.  The staffing crisis is reportedly most concerning in North Texas, however, including 29 nursing homes in Wichita County alone.  High nursing home turnover rates have been shown to produce negative outcomes in the quality of care, and in the overall health and wellbeing of staff.

Read on to learn more about nursing home turnover rates, how Medicaid funding impacts turnover and quality of care, and how to ensure your loved one gets the care that he or she deserves. 

If you have questions about your loved one’s legal rights, contact Nursing Home Abuse Center to speak with one of our nursing home abuse lawyers.

Nursing Home Turnover Causing Concern for Residents and Families

The high rate of turnover at nursing homes across the state is causing concern for residents and their families.  Seniors are already vulnerable, and many require specialized care or supervision.  When staffing is limited, quality and safety are often reduced, as is the peace of mind that families count on.

Recently, the THA released a report on staffing and quality of care among North Texas nursing homes, and the results were disheartening.  Consider the following:

  • North Texas counties employ around 2,626 caregivers.
  • The annual turnover rate for certified nurse aides (CNAs) is 97 percent.
  • The annual turnover for licensed vocational nurses and registered nurses (RNs) is 90 percent.
  • 50 percent of RNs and LVNs employed in nursing homes in 2010 were no longer employed in the long-term care industry just five years later in 2015.
  • Estimates suggest that by 2030, there will be a shortfall of registered nurses in North Texas topping 15,688 or more.

The healthcare market is extremely competitive, and in Texas, it seems that most educated and trained nursing personnel choose home health (46 percent) or public health (41 percent), rather than long-term care facilities (8 percent).

Why is Staffing Such a Big Problem in Texas?

According to the THA, one of the most significant contributors to the staffing crisis is the low Medicaid reimbursement rate in the state.  More than two-thirds of nursing home residents in Texas depend on Medicaid to cover cost of living, which makes the issue of funding even more significant.  Texas’ reimbursement rates are incredibly low, at just $144 per day, or $6 per hour.  Those rates fall around $10,000 less than the actual cost of caring for a Medicaid resident for one year.

For a nursing home capable of housing 100 residents, that shortfall equates to over $650,000 per year that the facility must make up elsewhere.  When there is a deficit in the amount of funds available, nursing homes are unable to adequately staff their facilities, or are forced to pay their staff less, which does not promote adequate education and training for the positions needed.  In fact, studies have shown that higher Medicaid reimbursement rates contribute to a better nursing home workforce, which in turn increases the quality of care and reduces the number of re-hospitalizations.

Add to the funding issues the fact that the labor market in Texas is highly competitive, and nursing homes struggling to fund their needs have a difficult time attracting quality staff.  These issues all compound into a high turnover rate and facilities struggling to support a full staff that can manage the needs of nursing home residents.  This further calls into question a facilities’ ability to provide quality care and a safe environment for residents.

What to Do about Nursing Home Turnover

According to Kevin Warren, President and CEO of the THA, nursing homes can combat funding issues and nursing home turnover by addressing these possibilities early on.  Nursing homes who pull in partners and create an attractive career environment can reduce turnover rates and promote safer, higher quality care.

Warren further states that healthcare officials are working hard to partner with schools who offer healthcare and long-term care education and training.  By partnering with educational institutions, long-term care is promoted as a valid career option, rather than just a “job”.  By providing more education and training, nursing homes have access to a larger pool of potential staff members, and can feel some peace of mind of their own that their residents will get quality care.

What Can Families Do?

If you are considering moving a loved one into a nursing home, of course you want to make sure that the facility is well staffed and equipped.  While it can be difficult to determine exactly how well staffed a facility is, there are some things you can do to get an idea of the level of care provided.  Consider the following:

  • Talk to caregivers and nurses about how long their shifts are, and how often they are asked to work overtime or double shifts.
  • Take note of how staff look, act, and interact with residents. Staff who seem stressed or frustrated, are openly arguing or complaining, or are not interacting with residents at all may be a warning sign.
  • Ask the administrator to use the Nursing Home Compare tool provided by to check staff-to-patient ratios.
  • Take a tour of the facility. Be aware of what you see, hear, and smell.  Unhappy residents, dirty facilities, or an unpleasant odor may be signs of understaffing or poor management.
  • Check reviews online and look for warning signs, such as complaints about staff, complaints filed, etc.

Whether you are considering moving a loved one or yourself, or have concerns about quality of care, anytime you have questions about a nursing home environment, it can be helpful to contact an attorney.  At Nursing Home Abuse Center we can help you ensure that you and your loved one’s legal rights are protected.  Contact us for any concerns about nursing home abuse or neglect, understaffing, or substandard care.  Fill out our online form, or call 1-800-516-4783 to request a free consultation.


meagan cline

Written By Meagan Cline

Meagan Cline is a professional legal researcher and writer. She lends her expertise to FNHA and our websites, including Birth Injury Guide and