Providers lament turnover costs
When a question posted to an on-line home health bulletin board sponsored by the publisher of Private Duty Homecare asked providers about turnover costs, many responded with comments about the frustrations and consequences of losing nursing assistants and home health aides. Here is some of what they said: (For more on how to calculate turnover costs, see story, p. 138.)
* "Another factor to be considered in turnover cost and one more difficult to calculate, is the loss of productivity. Even an experienced CNA will require time to learn facility specific policy/procedure and the new facility’s residents."
* "I’ve received estimates of $2,000 to $4,000 as the cost of replacing an experienced nurse assistant. This [amount] usually reflects interview time, training and testing, mentoring, the paper work associated with screening, police screening, and other front-end tasks. However, the few administrators whom I have talked with recognize the cost value to having inexperienced nurse assistants (NAs) providing care. First, there is the initial downtime because few new NAs can carry a full load the first day out of class. Then there is the time of the experienced NA who provides mentoring or coaching of the new NA.
"Many long-term care residents are disoriented and insecure and do better in stable surroundings. One of the frequent complaints of families is that no one really knows Mom as well as Nellie’ did. The loss of family satisfaction is costly. Another cost item is the loss of peer support especially when an experienced NA leaves. Experienced NAs anchor each other into the system, and when one leaves, the probability that others will leave increases dramatically."
* "There are also intangible costs of client satisfaction, family satisfaction, etc, which you probably couldn’t quantify, but are real."
* "Did you [know] a way to put a dollar amount on lack of continuity of care for the residents due to constant new, untrained faces, possible mismanagement of activities of daily living, having to teach new caregivers how one wants their prosthesis applied and their oral care done, etc.
"Also, [you need to include] disillusionment of long-time employees who constantly have to pick up the slack of working short [staff-challenged shifts], who are expected to work 56+ hours a week due to new employees not coming to work or quitting without notice, etc."
* "I know that more falls and injuries are related to new nursing assistants caring for people they are unfamiliar with. The residents also learn to stay detached from their caregivers because they will only be there a short time. Therefore they fail to develop a trusting relationship that is so desperately needed."
* "Beyond training there are issues related to the time it takes post-orientation to work at the same competency level as the NA who resigned. This may actually be positive or negative depending on the work ethic of the one who left.
"Some organizations replace their NAs with more expensive help, such as on-site RNs who know the system. This is also a cost to consider.
"There is also the cost of not replacing them until a new hire is trained. These costs are those associated with the risk and liabilities of less-than-required staffing levels."
* "There can be considerable aggregate cost accumulation if the person who quits is a longer-term employee, with a social’ bank of residents who preferred that aide’s help and now complain to the state surveyors and other residents. Costs can be reflected in staff morale issues, which reduce the so-called efficiency of facilities. If you are in the habit of hiring noncertified aides and paying them minimum wage and then turning them out after they complete a nurse aide training program, then there are fewer costs upfront, but you run the risk of losing profits downstream because your skill levels remain at the bottom of the barrel collectively.
"I think it is better to hire certified aides and pay them more to get and expect quality. Lots of smaller companies do not because they are into getting money, not earning profit from delivering quality care.
"At times the industry earns all the disrespect it has accumulated from the public trough and the wallets of the paying customers."
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content