Nursing homes in Texas and across the U.S. face high staff turnover rates due to exhaustion, lingering effects of the pandemic and staff’s tendency to leave long-term care facilities for other health care jobs, according to the American Health Care Association.

The context

In 2022, the median turnover rate for direct resident care registered nurses and licensed vocational nurses in long-term care facilities was over 50%, an increase from previous years, according to the Texas Center for Nursing Workforce Studies.

Leticia Caballero, director of government relations for HMG Healthcare, said a reason for the high turnover rates after the pandemic was exhaustion.

“In the hospital, it's more acute,” Caballero said. “You are healed, and then you are able to go home, and in long-term settings, you've got people that have got multiple health care needs and are having difficulty with what we call activities of daily living. They need help with bathing, toileting, eating, dressing. ... In a long-term care setting you've got to be able to make sure that kind of care is delivered.”

The Centers for Medicare and Medicaid Services rates U.S. nursing homes based on their quality of care and staffing. Families for Better Care, an Austin citizen advocacy group dedicated to creating public awareness of nursing home conditions, uses the ratings to compile state report cards. Texas received a grade of F and the lowest ranking out of the 50 states and Washington, D.C.

What they’re saying

The challenge of filling staff is ongoing in the Bay Area of Houston as well, said Michael Cummings, health care administrator for The Crossings Methodist Retirement Communities in League City.

Cummings also serves on the education board for nonprofit LeadingAge Texas, which provides services and advocacy for aging residents.

“[The nursing shortage] is a challenge that we deal with everyday,” Cummings said. “The stories we hear from a lot of [other] communities is tough. It’s hard to fill positions.”

Meanwhile, concerns over new mandates from the federal level, which could increase requirements for nursing homes, could prove difficult to overcome, Cummings said.

Looking ahead

New rules from the Centers for Medicare and Medicaid Services aim to combat poor quality of care in nursing homes. It outlines minimum staffing requirements that mostly impact RNs, LVNs and certified nursing assistants by requiring additional hours per resident day, which measures the hours of care a nursing home patient receives daily.

“It’s a great concern for the nursing home environment because while you can mandate these requirements, there are just not enough nurses or clinicians out there to meet this requirement. It's unrealistic,” Caballero said.

The Texas Center for Nursing Workforce Studies recommends several plans for improving staff retention and recruitment in long-term care facilities, including pay increases, recruitment plan improvements and educational partnerships.

Caballero said it will be important to emphasize the value of long-term care as a profession.

“I think if people were to come in and visit, and see the types of residents that we care for, ... retired teachers, retired law enforcement, people that have lived their whole lives not expecting to live to be 80, 90 years old and have all of these multiple health care needs—they have tremendous stories to tell. They've lived a long full life, and it's a great treasure to be able to take care of the people that we care for in the nursing home,” Caballero said.

James T. Norman contributed to this article.