Study Suggests Benefits of Adding Staffing Instability to Care Compare

August 16, 2023


Contact: Ellen Mullally

Studies have found that higher staffing levels are associated with better scores on quality measures reported as part of the Nursing Home Care Compare (NHCC) report card, fewer hospitalizations and emergency department visits, as well as fewer citations for deviations from state and federal quality standards. A study in the August issue of JAMDA observed that instability and turnover in total nursing home staffing independently contribute to nursing home quality. The authors also suggest that adding staffing instability to existing measures of average staffing and staff turnover in NHCC may enhance its value for providers engaged in quality improvement and consumers seeking high-quality care.

In New Dimensions of Staffing Patterns and Nursing Home Quality: Comparing Staffing Instability to Staffing Turnover, the authors explored correlations between staffing measures and estimated facility-level regression models with robust standard errors. For the 11,840 nursing homes in the study, there was a weak positive correlation between turnover and instability, with some overlap between homes with high instability and high turnover. The authors said, “Regression analysis revealed that staffing instability and turnover contributed independently to nursing home quality, with instability having a stronger association with some measures of quality and turnover with others.”

At the same time, the study showed that staffing instability was positively and more strongly associated with long-stay residents’ decline in activities of daily living (ADL) performance levels and receipt of antipsychotic drugs, as well as short-stay residents’ functioning at discharge. Turnover was positively and more strongly associated with the prevalence of pressure ulcers and worsening mobility in long-stay residents and hospitalizations in short-stay residents.

This study was conducted by researchers at the Department of Public Health Sciences, The University of Chicago Biological Sciences, Chicago, IL; Public Health and Nursing, Information Technology Enhancing Quality Care Research Program, University of California Irvine, Irvine, CA; Borun Center at University of California Los Angeles, Los Angeles, CA; and Division of General Internal Medicine, Department of Medicine, iTEQC Research Program, University of California Irvine, Irvine, CA.

Get more information on the findings above and more details about the study. To contact the researchers or JAMDA editors for an interview, please email





JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics important to post-acute and long-term care medicine. Visit for more information.

About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.