ArticleJournal of the American Medical Directors Association2026
Effect of Staffing and Wages on Turnover of Nonclinical Support Staff in Nursing Homes.
Article in Journal of the American Medical Directors Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesHousekeeping, dietary, laundry, and maintenance workers play a critical role in nursing home quality and safety. High turnover among these workers disrupts care, increases costs, and undermines facility stability. However, little is known about the role of staffing and wages on turnover for these roles. The objective of this study is to estimate the effect of staffing and wages on the turnover of housekeeping, dietary, laundry, and maintenance workers.
designRetrospective study. SETTING AND
participantsA total of 418 unique nursing homes with 4428 observations in Iowa from 2011 to 2022.
methodsWe define turnover rates using the number of employees in a given job type who left during the year, divided by the average number of employees in that job type at the facility. Our main predictor variables were average staff size and hourly wage rates. We used robust facility-fixed effects linear regressions to estimate the impact of staffing and wages on turnover.
resultsEach additional dollar in hourly wages was associated with a reduction in turnover of 3.50 percentage points for dietary staff, 3.83 for housekeeping, 1.17 for maintenance, and 3.12 for laundry (all P < .001). Similarly, increasing average staff size by 1 worker was associated with a reduction in turnover of 0.95 percentage points for dietary staff, 2.06 for housekeeping, and 2.99 for laundry. Effects were broadly consistent but larger in for-profit and urban facilities. CONCLUSIONS AND IMPLICATIONS: Our findings suggest that improving wages and staffing levels may be effective strategies for reducing turnover among nursing home support staff, particularly in for-profit and urban facilities.
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