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Employee Turnover in the Long-Term Care Industry: 2004 NNAS and NNHS Data William Even Miami University & David Macpherson Florida State University.

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Presentation on theme: "Employee Turnover in the Long-Term Care Industry: 2004 NNAS and NNHS Data William Even Miami University & David Macpherson Florida State University."— Presentation transcript:

1 Employee Turnover in the Long-Term Care Industry: 2004 NNAS and NNHS Data William Even Miami University & David Macpherson Florida State University

2 Background Employment in nursing and residential care facilities Employment in nursing and residential care facilities grew from 2.0 to 2.7 million between 1992 and 2002grew from 2.0 to 2.7 million between 1992 and 2002 Projected to grow toProjected to grow to 3.7 million by 2012 (BLS) 3.7 million by 2012 (BLS) 6 million by 2050 (DHHS). 6 million by 2050 (DHHS). Florida Florida First in percentage of people over age 75First in percentage of people over age 75 8.9 percent in Florida 8.9 percent in Florida 5.0 percent in California 5.0 percent in California

3 Turnover in LTC Decker et al. 2003: turnover is Decker et al. 2003: turnover is 70 percent for certified nursing assistants70 percent for certified nursing assistants 50 percent for nurses50 percent for nurses 100,000 FTE vacancies at nursing homes100,000 FTE vacancies at nursing homes GAO (2001): turnover among nurse aides working in nursing homes is: GAO (2001): turnover among nurse aides working in nursing homes is: 13-18% percent higher than the overall labor force13-18% percent higher than the overall labor force 20% higher than other service workers. 20% higher than other service workers.

4 Turnover in LTC Turnover is costly Turnover is costly Screening, training, reduced quality of care.Screening, training, reduced quality of care. Replacement cost for nursing home assistant = 4 months salary (Pillemer 1996)Replacement cost for nursing home assistant = 4 months salary (Pillemer 1996)

5 Turnover in LTC Why is turnover so high? (HHS 2002, 2003) Why is turnover so high? (HHS 2002, 2003) wages and benefitswages and benefits working conditionsworking conditions trainingtraining staffing levelsstaffing levels potential for career advancementpotential for career advancement

6 Project Objectives Does the measure of turnover or data set affect conclusions? Does the measure of turnover or data set affect conclusions? What factors influence the level of turnover? What factors influence the level of turnover? How does exposure to turnover differ across race and gender for nursing home residents? How does exposure to turnover differ across race and gender for nursing home residents?

7 2004 National Nursing Assistant Survey (NNAS) Supplement to 2004 National Nursing Home Survey (NNHS) Supplement to 2004 National Nursing Home Survey (NNHS) 3,017 Nursing Assistants surveyed at 582 nursing homes3,017 Nursing Assistants surveyed at 582 nursing homes Four turnover measures Four turnover measures How much turnover is there of nursing assistants at facility?How much turnover is there of nursing assistants at facility? How likely is it that NA leaves current job during next year?How likely is it that NA leaves current job during next year? Is NA currently looking for different job, either as a nursing assistant or something else?Is NA currently looking for different job, either as a nursing assistant or something else? Job tenure (in months)Job tenure (in months)

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12 Turnover Analysis of NNAS Methodology: Methodology: Logit for Looking for Different Job, How Much Turnover at Facility, How Likely Will Leave Job in Next Year, How Much Does Turnover InterfereLogit for Looking for Different Job, How Much Turnover at Facility, How Likely Will Leave Job in Next Year, How Much Does Turnover Interfere Demographic Characteristics: Demographic Characteristics: Age and Age^2Age and Age^2 Female (-)Female (-) Hispanic (+)Hispanic (+) African-AmericanAfrican-American AsianAsian Years of SchoolingYears of Schooling English Main LanguageEnglish Main Language Spanish Main LanguageSpanish Main Language U.S. CitizenU.S. Citizen

13 Turnover Analysis of NNAS MarriedMarried Divorced or Separated (+)Divorced or Separated (+) Training: Training: Received Training Before 1987Received Training Before 1987 Employer Paid All Training CostsEmployer Paid All Training Costs Employer Paid for Some TrainingEmployer Paid for Some Training Trained in Nursing FacilityTrained in Nursing Facility Trained in Community CollegeTrained in Community College Compensation: Compensation: Hourly Wage (-)Hourly Wage (-) In Pension PlanIn Pension Plan In Health InsuranceIn Health Insurance Bonuses (-)Bonuses (-)

14 Turnover Analysis of NNAS Tenure/Working Conditions: Tenure/Working Conditions: Tenure (-)Tenure (-) Work Mandatory Overtime (+)Work Mandatory Overtime (+) Desire to Work More Hours (+)Desire to Work More Hours (+) Desire to Work Fewer Hours (+)Desire to Work Fewer Hours (+) # Times Injured at Facility# Times Injured at Facility Time Off for Good Work (-)Time Off for Good Work (-) Percent UnionPercent Union Facility Characteristics: Facility Characteristics: Facility Part of ChainFacility Part of Chain For Profit FacilityFor Profit Facility Clusters of Beds for Alzheimer's and Related Dementias (+)Clusters of Beds for Alzheimer's and Related Dementias (+) Cluster of Beds for Behavior Unit (Non-Alzheimer's)Cluster of Beds for Behavior Unit (Non-Alzheimer's) Cluster of Beds for RehabilitationCluster of Beds for Rehabilitation Number of BedsNumber of Beds

15 Turnover Analysis of NNAS Facility Characteristics: Facility Characteristics: Occupancy RateOccupancy Rate Percent of Patients on MedicarePercent of Patients on Medicare Percent of Patients on MedicaidPercent of Patients on Medicaid Does Facility Have a Waiting List?Does Facility Have a Waiting List? Director of Nursing Tenure (-)Director of Nursing Tenure (-) Medical Director TenureMedical Director Tenure Nursing Hours Per Patient Per Day (-)Nursing Hours Per Patient Per Day (-)

16 2004 NNHS Data Survey of 1174 facilities Survey of 1174 facilities Three turnover measures Three turnover measures Percent of FTE workers who left in prior 3 monthsPercent of FTE workers who left in prior 3 months left percent=(number FT workers who left +.5*number PT workers who left)/number of FTEs left percent=(number FT workers who left +.5*number PT workers who left)/number of FTEs Percent of FTE positions vacantPercent of FTE positions vacant Percent of workers with at least one year of job tenurePercent of workers with at least one year of job tenure Analyze Data with Tobit models Analyze Data with Tobit models

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20 Turnover Analysis of NNHS Compensation:RNLPNCNA Starting Wage Starting Wage Health Insurance Health Insurance Pension Pension--- Working Conditions: Percent Working Over Time Percent Working Over Time+++ Union Union-- Facility Characteristics: Part of a Chain Part of a Chain+ For Profit Facility For Profit Facility+/- Alzheimer's Beds Alzheimer's Beds

21 Turnover Analysis of NNHS Facility Characteristics: RNLPNCNA Behavior Beds – Non Alzheimers Behavior Beds – Non Alzheimers Rehabilitation Beds Rehabilitation Beds Number of Beds Number of Beds++ Occupancy Rate Occupancy Rate+- Percent Medicare Percent Medicare Percent Medicaid Percent Medicaid-+ Nursing Hours Per Patient Per Day Nursing Hours Per Patient Per Day--- Does Facility Have a Waiting List? Does Facility Have a Waiting List? Director Nursing Tenure Director Nursing Tenure--- Medical Director Tenure Medical Director Tenure

22 Racial Difference in Means for Residents Both Sexes Sample Size Means WhiteBlackWhiteBlackDiff Age12,1011,40681.274.96.3* Female12,1011,4060.720.630.09* Depressed Mood 11,9581,3830.620.530.08* Total ADLs 12,0111,3914.064.16-0.09 Restraints Used 12,0371,3940.380.47-0.08* Private Health Insurance 11,5581,3250.120.060.06* Medicaid11,5581,3250.340.56-0.23*

23 Racial Difference in Means for Residents Sample Size Means MEN Age3,35551376.068.97.0* Depressed Mood 3,3025080.560.500.06 Total ADLs 3,3225083.903.95-0.06 Restraints Used 3,3335090.370.46-0.09* Private Health Insurance 3,1954730.120.060.06* Medicaid3,1954730.330.55-0.22* WOMEN WhiteBlackWhiteBlackDiff Age8,74689383.278.34.9* Depressed Mood 8,6568750.640.550.08* Total ADLs 8,6898834.124.27-0.15* Restraints Used 8,7048850.390.47-0.08* Private Health Insurance 8,3638520.120.060.06* Medicaid8,3638520.340.57-0.23*

24 Staff Turnover by Resident Race BOTH SEXES Sample Sizes No Controls Controls WhiteBlackWhiteBlackDiffDiff Percent of Staff Leaving in Last Three Months RNs RNs11046123313.1%15.9%-2.8%-1.8% LPNs LPNs10916120811.7%13.5%-1.8%-1.6% CNAs CNAs10829117916.8%15.5%1.4%2.2% Vacancies as a Percent of FTEs RNs RNs11031124811.9%10.5%1.4%2.4% LPNs LPNs1089612289.7%7.3%2.3%*2.7%* CNAs CNAs1084312016.4%4.7%1.7%*1.7%* Controls include age and controls for patient's mental and physical health, length of stay, payment type, and per diem rate.

25 Staff Turnover by Resident Race WOMEN Sample Sizes No Controls Controls WhiteBlackWhiteBlackDiffDiff Percent of Staff Leaving in Last Three Months RNs RNs802779812.9%14.5%-1.7%-2.4% LPNs LPNs792878011.8%13.3%-1.5%-1.6% CNAs CNAs786276516.4%15.0%1.5%1.9% Vacancies as a Percent of FTEs RNs RNs801480111.8%10.3%1.5%2.4% LPNs LPNs79117879.8%7.4%2.4%*2.7%* CNAs CNAs78737736.3%4.8%1.5%*1.4%* Controls include age and controls for patient's mental and physical health, length of stay, payment type, and per diem rate.

26 Staff Turnover by Resident Race MEN Sample Sizes No Controls Controls WhiteBlackWhiteBlackDiffDiff Percent of Staff Leaving in Last Three Months RNs RNs301943513.9%18.4%-4.5%-0.5% LPNs LPNs298842811.3%13.9%-2.6%-1.5% CNAs CNAs296741417.9%16.4%1.5%2.5% Vacancies as a Percent of FTEs RNs RNs301744712.3%10.9%1.4%2.2% LPNs LPNs29854419.5%7.3%2.2%*2.6%* CNAs CNAs29704286.7%4.5%2.2%*2.2%* Controls include age and controls for patient's mental and physical health, length of stay, payment type, and per diem rate.

27 Conclusions Turnover is a significant problem for nursing homes. Turnover is a significant problem for nursing homes. Working conditions and compensation affect level of turnover Working conditions and compensation affect level of turnover Little evidence that facility type (size, case mix) affects turnover Little evidence that facility type (size, case mix) affects turnover Significant racial differences in the age, health, and payments methods for nursing home residents Significant racial differences in the age, health, and payments methods for nursing home residents Despite these differences, there are only modest racial differences in resident exposure to turnover. Despite these differences, there are only modest racial differences in resident exposure to turnover.

28 Appendix Appendix

29 Turnover analysis of NNAS Variable Likely Leave Job Next Year Looking for Different Job How Much Turnover? How Much Interfere? Age-0.01080.0050 (1.41)(0.63) Age^2/1000.0105-0.0103 (1.10)(1.04) Female-0.0549-0.1501 (1.18)(3.27) Hispanic-0.1438-0.1824 (2.18)(2.61) Black0.04830.0432 (1.45)(1.38) Asian0.01080.0207 (0.13)(0.24) Years of Schooling 0.01390.0131 (1.61)(1.57) English Main Language -0.0957-0.1266 (1.39)(1.77) Spanish Main Language 0.09350.0611 (0.83)(0.56)

30 Turnover analysis of NNAS Variable Likely Leave Job Next Year Looking for Different Job How Much Turnover? How Much Interfere? U.S. Citizen -0.03820.0728 (0.57)(1.18) Married0.00330.0263 (0.09)(0.77) Divorced or Separated 0.09960.1497 (2.58)(3.92) Receive Job Training Before 1987 0.0042-0.01340.03430.0503 (0.11)(0.35)(1.01)(0.05) Employer Paid All Training Costs -0.0437-0.04460.0247-0.0199 (1.25)(1.29)(0.92)(0.02) Employer Paid for Some Training 0.01860.03060.0398-0.0932 (0.33)(0.56)(0.89)(0.09) Trained in Nursing Facility 0.02930.03700.00540.0518 (0.82)(1.04)(0.19)(0.05) Trained in Community College 0.00530.02040.00210.0747 (0.13)(0.51)(0.06)(0.07) Ln (hourly wage) -0.1659-0.1112-0.1609-0.1865 (2.31)(1.49)(2.12)(0.19)

31 Turnover analysis of NNAS Variable Likely Leave Job Next Year Looking for Different Job How Much Turnover? How Much Interfere? Pension Plan -0.0387-0.0234-0.0503-0.0021 (1.27)(0.81)(1.62)(0.00) In Health Insurance Plan -0.0357-0.0439-0.0182-0.0465 (1.42)(1.59)(0.76)(0.05) Job tenure (in months ) -0.0015-0.00050.00060.0004 (2.61)(0.93)(1.34)(0.00) Job Tenure^2/100 0.0003-0.0001-0.00010.0000 (1.52)(0.34)(0.51)(0.00) Work Mandatory Overtime 0.08760.06780.11100.2102 (2.51)(2.06)(3.56)(0.21) Desire to Work More Hours 0.02850.07240.0060-0.0780 (0.80)(2.01)(0.19)(0.08) Desire to Work Fewer Hours 0.26570.31010.10110.1338 (6.01)(7.17)(1.98)(0.13) # times injured at facility -0.00060.00060.00440.0101 (0.37)(0.36)(1.51)(0.01) Time off for good work -0.0318-0.0032-0.1053-0.0962 (0.56)(0.06)(3.03)(0.10)

32 Turnover analysis of NNAS Variable Likely Leave Job Next Year Looking for Different Job How Much Turnover? How Much Interfere? Bonuses-0.0396-0.06680.01700.0181 (1.27)(2.14)(0.66)(0.02) Facility Part of a Chain -0.0118-0.0353-0.03220.0146 (0.41)(1.26)(1.13)(0.01) For Profit Facility 0.05940.0440-0.00970.0264 (1.80)(1.46)(0.31)(0.03) Clusters of Beds for Alzheimers -0.02730.01760.11540.0716 and Related Dementias (0.86)(0.62)(3.71)(0.07) Cluster of Beds for Behavior Unit 0.04300.0210-0.0015-0.0308 (Non-Alzheimers)(0.57)(0.32)(0.02)(0.03) Cluster of Beds for Rehabilitation 0.02490.0307-0.0590-0.0392 (0.51)(0.73)(1.36)(0.04) Number of Beds -0.0003-0.00010.0000-0.0002 (1.40)(0.68)(0.14)(0.00) Occupancy Rate -0.01310.05420.1111-0.1316 (0.10)(0.45)(0.82)(0.13)

33 Turnover analysis of NNAS Variable Likely Leave Job Next Year Looking for Different Job How Much Turnover? How Much Interfere? Percent of Patients on Medicare -0.02930.2273-0.0293-0.2456 (0.20)(1.88)(0.28)(0.25) Percent of Patients on Medicaid -0.1250-0.03890.0349-0.0676 (1.5)(0.57)(0.44)(0.07) Does Facility Have Waiting List 0.04170.0354-0.0480-0.0129 (1.31)(1.16)(1.52)(0.01) Director Nursing Tenure 0.00140.0009-0.0052-0.0032 (0.60)(0.44)(2.40)(0.00) Medical Director Tenure -0.0001-0.0008-0.0017-0.0002 (0.05)(0.42)(0.80)(0.00) Percent Union 0.02020.00780.0255-0.0148 (1.11)(0.38)(1.01)(0.01) Nursing Hours Per Patient Per Day -0.0126-0.0202-0.0050-0.0110 (2.69)(4.03)(1.22)(0.01) Obs1,5651,5651,5701,570

34 Turnover analysis of NNHS: RNS Variable%Left%Vacancy % Tenure>1 Starting Wage 0.0003210.00126-0.0624 (0.14)(0.82)(-0.22) Health Insurance 0.03940.02117.059 (1.30)(0.86)(1.30) Pension-0.01890.0009889.480*** (-1.03)(0.075)(3.53) % Working over time 0.05620.0874***-2.009 (1.56)(3.95)(-0.46) Union0.0177-0.002695.400 (0.68)(-0.15)(1.22) Facility Part of a Chain 0.0299*-0.00954-8.156*** (1.65)(-0.67)(-2.95) For Profit Facility -0.00149-0.00777-1.418 (-0.084)(-0.49)(-0.49) Clusters of Beds for Alzheimers 0.00504-0.0116-1.779 (0.29)(-0.87)(-0.65) Clusters of Beds for Behavior 0.04000.01351.434 (0.62)(0.46)(0.20)

35 Turnover analysis of NNHS: RNS Variable%Left%Vacancy % Tenure>1 Cluster of Beds for Rehabilitation 0.008250.0342*-2.839 (0.39)(1.92)(-0.77) # Beds: 50-990.0712**-0.0185-5.527 (1.97)(-0.72)(-1.29) 100-1990.111***-0.00849-8.637** (3.06)(-0.33)(-1.97) 200+0.180**0.02800.109 (2.06)(0.85)(0.020) Occupancy Rate: 70-79-0.006280.007739.953* (-0.16)(0.24)(1.80) 80-89-0.02260.031014.47*** (-0.74)(1.20)(3.19) 90-94-0.0256-0.00004228.800* (-0.76)(-0.0017)(1.90) 95+-0.0589*-0.00039714.61*** (-1.94)(-0.017)(3.22)

36 Turnover analysis of NNHS: RNS Variable%Left%Vacancy % Tenure>1 Percent on Medicare: 10-190.004480.00764-2.537 (0.23)(0.52)(-0.88) 20+0.009300.0109-3.150 (0.37)(0.54)(-0.75) Percent on Medicaid: 20-39-0.0546*0.0130-2.733 (-1.90)(0.40)(-0.43) 40-59-0.03370.0252-4.064 (-1.12)(0.86)(-0.72) 60-79-0.0659**0.0249-4.649 (-2.12)(0.89)(-0.83) 80+-0.0807***0.00419-2.211 (-2.59)(0.13)(-0.35)

37 Turnover analysis of NNHS: RNS Variable%Left%Vacancy % Tenure>1 Nursing Hours Per Patient Per Day: 2-2.99-0.157***-0.0658**23.73*** (-3.18)(-2.15)(3.78) 3-3.99-0.126***-0.0507*18.88*** (-2.76)(-1.68)(3.03) 4-4.99-0.0944***-0.0606**19.18** (-2.85)(-2.45)(2.49) 5-11.99-0.127***-0.044921.54*** (-4.72)(-1.57)(2.73) 12+-0.118***-0.0636***25.44*** (-4.47)(-2.81)(3.11) Does Facility Have Waiting List 0.00614-0.0256*-2.937 (0.36)(-1.88)(-1.10) Director Nursing Tenure -0.00803***-0.002122.640*** (-3.84)(-1.48)(9.36) Medical Director Tenure 0.00311*0.001550.265 (1.95)(1.40)(1.13) Observations909909908

38 Turnover analysis of NNHS: LPNS Variable%Left%Vacancy % Tenure>1 Starting Wage 0.000881-0.0001950.148 (0.54)(-0.13)(0.41) Health Insurance 0.02720.02183.424 (1.44)(1.29)(0.87) Pension-0.0324***0.001274.159** (-2.87)(0.13)(2.03) % Working over time 0.03340.0795***-4.829 (1.64)(5.35)(-1.37) Union-0.0258*0.0333*6.834** (-1.86)(1.84)(1.98) Facility Part of a Chain 0.0131-0.0193*-4.205* (1.15)(-1.81)(-1.89) For Profit Facility 0.00765-0.0215*-2.142 (0.66)(-1.75)(-0.89) Clusters of Beds for Alzheimers 0.01060.00545-1.556 (1.00)(0.53)(-0.71) Clusters of Beds for Behavior 0.04340.0250-7.241 (1.14)(0.95)(-1.61)

39 Turnover analysis of NNHS: LPNS Variable%Left%Vacancy % Tenure>1 Cluster of Beds for Rehabilitation 0.04340.0250-7.241 (1.14)(0.95)(-1.61) # Beds: 0.004620.0236-1.244 50-99(0.34)(1.46)(-0.38) (1.97)(-0.72)(-1.29) 100-1990.02820.0225-8.277** (1.28)(1.05)(-2.18) 200+0.0622***0.0205-12.73*** (2.81)(1.04)(-3.42) Occupancy Rate: 0.0746**0.0471*-5.641 70-79(2.39)(1.67)(-1.17) (-0.16)(0.24)(1.80) 80-890.00126-0.020110.88** (0.053)(-1.06)(2.52) 90-94-0.0118-0.01466.183 (-0.61)(-0.86)(1.61) 95+-0.0132-0.02394.346 (-0.66)(-1.37)(1.15)

40 Turnover analysis of NNHS: LPNS Variable%Left%Vacancy % Tenure>1 Percent on Medicare: 10-190.002320.01300.564 (0.20)(1.22)(0.26) 20+0.004000.02350.245 (0.24)(1.36)(0.068) Percent on Medicaid: 20-390.01880.0173-6.676 (0.75)(0.62)(-1.19) 40-59-0.002540.0373-0.0350 (-0.12)(1.45)(-0.0074) 60-790.008630.0317-3.303 (0.40)(1.40)(-0.69) 80+0.00246-0.006640.0909 (0.096)(-0.30)(0.017)

41 Turnover analysis of NNHS: LPNS Variable%Left%Vacancy % Tenure>1 Nursing Hours Per Patient Per Day: 2-2.99-0.0612**-0.0364*7.665 (-2.08)(-1.75)(1.59) 3-3.99-0.0619**-0.0463**6.924 (-2.19)(-2.23)(1.44) 4-4.99-0.0490*-0.0675***4.569 (-1.91)(-4.66)(0.77) 5-11.99-0.0916***-0.01844.994 (-5.11)(-0.71)(0.83) 12+-0.0873***-0.0428**9.288* (-5.41)(-2.55)(1.71) Does Facility Have Waiting List -0.00686-0.01131.201 (-0.54)(-1.04)(0.55) Director Nursing Tenure -0.00345***-0.001631.613*** (-2.93)(-1.58)(6.87) Medical Director Tenure -0.00178*-0.0007460.270 (-1.82)(-0.85)(1.37) Observations914915911

42 Turnover analysis of NNHS: CNAS Variable%Left%Vacancy%Tenure>1 Starting Wage -0.00363-0.001750.456* (-1.59)(-1.43)(1.75) Health Insurance -0.0363-0.002384.543* (-1.43)(-0.25)(1.78) Pension-0.0009020.008175.121*** (-0.073)(1.44)(3.44) % Working over time 0.0703**0.0612***-5.148* (2.19)(4.76)(-1.75) Union-0.0412***0.008104.343** (-3.37)(0.97)(2.02) Facility Part of a Chain 0.00826-0.000466-2.317 (0.74)(-0.080)(-1.46) For Profit Facility 0.0327***-0.0155**-1.665 (2.96)(-2.56)(-1.04) Clusters of Beds for Alzheimers 0.0186*0.00647-2.734 (1.66)(1.06)(-1.64) Clusters of Beds for Behavior 0.1710.00633-8.843*** (1.29)(0.45)(-2.84)

43 Turnover analysis of NNHS: CNAS Variable%Left%Vacancy%Tenure>1 Cluster of Beds for Rehabilitation -0.0278*0.009220.118 (-1.90)(1.02)(0.046) # Beds: 50-990.0332*-0.00555-0.481 (1.92)(-0.58)(-0.20) 100-1990.0522***-0.0159-1.599 (3.00)(-1.60)(-0.65) 200+0.0350-0.01375.064 (1.36)(-1.01)(1.52) Occupancy Rate: 70-79-0.01230.008026.964** (-0.50)(0.61)(2.15) 80-89-0.02430.001063.950 (-0.98)(0.097)(1.34) 90-94-0.0392*0.005756.052** (-1.92)(0.52)(2.06) 95+-0.0549***-0.005876.565** (-2.59)(-0.54)(2.15)

44 Turnover analysis of NNHS: CNAS Variable%Left%Vacancy % Tenure>1 Percent on Medicare: 10-190.0228*-0.00236-0.256 (1.79)(-0.38)(-0.16) 20+-0.00007160.00746-2.702 (-0.0041)(0.80)(-1.01) Percent on Medicaid: 20-390.02480.0103-7.111* (1.09)(0.81)(-1.82) 40-590.0467**0.0236**-8.013*** (1.99)(2.02)(-2.70) 60-790.004030.0241**-8.346*** (0.19)(2.21)(-2.90) 80+-0.008630.000804-4.075 (-0.35)(0.066)(-1.23)

45 Turnover analysis of NNHS: CNAS Variable%Left%Vacancy%Tenure>1 Nursing Hours Per Patient Per Day: 2-2.99-0.119**-0.0410**1.558 (-2.18)(-2.27)(0.40) 3-3.99-0.115**-0.0400**1.907 (-2.27)(-2.26)(0.49) 4-4.99-0.123***-0.0492***0.780 (-3.32)(-4.41)(0.17) 5-11.99-0.139***-0.0337**3.453 (-3.86)(-2.07)(0.71) 12+-0.158***-0.0492***2.981 (-6.07)(-4.89)(0.52) Does Facility Have Waiting List 0.0177-0.00141-2.241 (1.61)(-0.23)(-1.33) Director Nursing Tenure -0.00236**-0.00163***1.015*** (-2.06)(-2.65)(6.38) Medical Director Tenure -0.001100.0006550.101 (-1.19)(1.17)(0.75) Observations911914907


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