Journal article
Effect of Staffing and Wages on Turnover of Non-Clinical Support Staff in Nursing Homes
Journal of the American Medical Directors Association, Vol.27(10), p.106452
09/02/2026
DOI: 10.1016/j.jamda.2026.106452
PMID: 42685658
Abstract
Objectives
Housekeeping, dietary, laundry, and maintenance workers play a critical role in nursing home quality and safety. High turnover among these workers disrupts care, increases costs, and undermines facility stability. However, little is known about the role of staffing and wages on turnover for these roles. The objective of this study is to estimate the effect of staffing and wages on the turnover of housekeeping, dietary, laundry, and maintenance workers.
Design
Retrospective study.
Setting and Participants
A total of 418 unique nursing homes with 4428 observations in Iowa from 2011 to 2022.
Methods
We define turnover rates using the number of employees in a given job type who left during the year, divided by the average number of employees in that job type at the facility. Our main predictor variables were average staff size and hourly wage rates. We used robust facility-fixed effects linear regressions to estimate the impact of staffing and wages on turnover.
Results
Each additional dollar in hourly wages was associated with a reduction in turnover of 3.50 percentage points for dietary staff, 3.83 for housekeeping, 1.17 for maintenance, and 3.12 for laundry (all P < .001). Similarly, increasing average staff size by 1 worker was associated with a reduction in turnover of 0.95 percentage points for dietary staff, 2.06 for housekeeping, and 2.99 for laundry. Effects were broadly consistent but larger in for-profit and urban facilities.
Conclusions and Implications
Our findings suggest that improving wages and staffing levels may be effective strategies for reducing turnover among nursing home support staff, particularly in for-profit and urban facilities.
Details
- Title: Subtitle
- Effect of Staffing and Wages on Turnover of Non-Clinical Support Staff in Nursing Homes
- Creators
- Hari Sharma - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Journal of the American Medical Directors Association, Vol.27(10), p.106452
- DOI
- 10.1016/j.jamda.2026.106452
- PMID
- 42685658
- NLM abbreviation
- J Am Med Dir Assoc
- ISSN
- 1525-8610
- eISSN
- 1538-9375
- Publisher
- Elsevier
- Grant note
- National Institute for Occupational Safety and Health (NIOSH) of the Centers for Disease Control and Prevention (CDC): R03OH012519
This work was supported by the National Institute for Occupational Safety and Health (NIOSH) of the Centers for Disease Control and Prevention (CDC) under award number R03OH012519. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIOSH or the CDC.
- Language
- English
- Date published
- 09/02/2026
- Academic Unit
- Health Management and Policy
- Record Identifier
- 9985242771602771
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