(Des Moines, Iowa) – A new state report on staffing in Iowa nursing homes indicates employee turnover rates are continuing to climb 15 years after state lawmakers approved, but failed to fund, a program to address the issue. According to the Iowa Capital Dispatch, the 2024 Nursing Facility Turnover Report from the Iowa Department of Health and Human Services indicates that between 2022 and 2023, the average rate of turnover among registered nurses working in nursing homes increased from 52% to 66%. Among licensed practical nurses, turnover increased from 53% to 68%.

Among certified nurse aides, who provide much of the hands-on care in Iowa nursing homes, the average turnover rate increased from 72% to 77%. Turnover rates reflect the percentage of workers who left their job during the course of a year. If a nursing home had nine aides on staff and seven of them left during the year, the turnover rate would be just under 78%. If 18 aides vacated those nine positions during the year, the turnover rate would be 200%.

The federal Centers for Medicare and Medicaid Services considers high staff turnover to be a major contributor to lesser quality care, in part because newly hired or temp-agency nurses and aides don’t know the residents and their needs.

According to the report, the Iowa home with the highest turnover rate among caregivers in 2023 was Northbrook Healthcare and Rehabilitation Center, formerly Northbrook Manor, in Cedar Rapids. The home saw a 612% turnover among its CNAs, a 667% turnover among LPNs, and a 720% turnover in registered nurses. In the position of administrator, there was a 300% turnover at Northbrook, indicating three different administrators left the facility over the course of just one year.

Some of the Iowa nursing home chains that have been cited for significant regulatory violations are also among those with the highest reported turnover. For example, homes that are part of the Aspire chain are run by a Florida for-profit company called Beacon Health Management that saw two of its Iowa facilities closed by the state in 2024. Three of the chain’s homes reported turnover rates of 300% or more in 2023.

On the other end of the spectrum, 14 of the 16 Iowa nursing homes run by the nonprofit Good Samaritan Society reported no turnover whatsoever among all of their nurses and CNAs, according to the new report. According to DHHS, the state-run Iowa Veterans Home did not report employee retention data to Iowa Medicaid for 2023, and so it was excluded from the statewide report on turnover.

The DHHS report suggests the turnover rate in Iowa nursing homes continues to outpace that of many other states. In 2022, the Long-Term Care Community Coalition reported that nationally, the average nursing home had an annual turnover rate of 53.3% among nursing staff. A separate set of data published by the Centers for Medicare and Medicaid Services indicates that in fiscal year 2023, 14% of Iowa’s 422 nursing facilities were cited for insufficient staffing. That was more than double the national average, which was 5.9%.

Only five other states — Hawaii, Michigan, Montana, New Mexico and Oregon — had a worse record of compliance with new federal staffing requirements. Iowa’s neighboring states of Nebraska, South Dakota, Wisconsin and Missouri had no more than 2% to 6.8% of their facilities cited for insufficient staffing in 2023.