Staff Retention Continues to Be Challenging in Long-Term Care Facilities


Building trust between patients, their families, and long-term care staff allows residents to feel comfortable with the very personal care that they receive.

Retaining staff and facility administrators in long-term care facilities continues to be challenging after the height of the COVID-19 pandemic, despite the importance of care continuity for patients, according to researchers.

The pandemic exacerbated and drew attention to staffing challenges for nursing home residents, their families, and other health care workers in long-term care environments. Further, recruiting and retaining staff have become significant challenges in recent years.

Researchers from the Regenstrief Institute and Indiana University School of Medicine noted that continuity of staff and leadership has been associated with improving quality of resident care in long-term care facilities, including onsite treatment, post-hospital care, assistance with basic care needs, and more. To discuss the issue further, researchers Jennifer L. Carnahan, MD, MPH, and Kathleen Unroe, MD, MHA, wrote an editorial published in the Journal of the American Geriatrics Society.

According to Carnahan and Unroe, building trust between patients, their families, and long-term care staff allows residents to feel comfortable with the very personal care that they receive. In addition to focusing on tasks, caregivers in such environments must know and interact personally with residents.

In addition to impacting the trust with patients, staff turnover can affects patients’ families as well. Family members rely on staff to care for their loved ones and keep them apprised of changes to their family members’ health and lifestyle. Changes in patients in long-term care can be subtle, including mood changes, loss of interest in activities, or inability to perform a task that they could previously accomplish, necessitating close attention from long-term care staff.

“Doctors and nurses are obviously important, but it should be recognized that frontline nursing home staff deliver 90% of care and thus are critical to creating a high-quality long-term care system,” Unroe said in a press release. “Everyone agrees we have a recruitment and retention problem. We need to devise incentives to attract and keep people in this workforce who enjoy working with older adults and are well trained, especially in the needs of people with dementia.”

Unroe, a geriatrician and past chair of the American Geriatrics Society Public Policy Committee, currently serves as a member of the technical expert panel of the Centers for the Medicare & Medicaid Services Five-Star Quality Rating System. In the editorial, Unroe said the tool provides more than 100 quality metrics divided into 5 categories: mortality, safety of care, readmission to hospitals, patient experience, and timely and effective care. These measurements allow patients, their families, social services, and others to compare quality of care at facilities.

“We need to prioritize nurturing and supporting staff so that they can deliver the hands-on care nursing home residents require,” Carnahan said in the press release. “Given the importance of continuity to quality of care for this vulnerable population and the current lack of viable solutions to improve staff and leadership recruitment and retention, researchers, in partnership with nursing home operators, must take the lead in developing and testing practical and reproduceable strategies to attract and keep a talented workforce and leadership.”


Staff and facility administrator retention has been challenging for long-term care facilities. News release. Regenstrief Institute; August 4, 2022. Accessed August 10, 2022.

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