An Assessment of the Long-Term Care Workforce Services in the State of Washington Part 1: A Quantitative Analysis
Abstract
Executive Summary
The challenges associated with staffing long-term care services across the state are well documented. Moving into the next decade, the need for caregivers will continue to grow. Over the past 18 months, the Workforce Board and the University of Washington Center for Health Workforce Studies have undertaken a systematic qualitative and quantitative assessment of the long-term care (LTC) workforce in Washington State. Part 1 of the 2025 LTC Workforce Initiative Report to the Legislature describes results from the quantitative analysis. Key takeaways from this research include:
- Short-term and long-term quality measures were generally better for WA nursing homes (NH) than the average of all U.S. NHs.
- NH turnover rates for nursing staff in WA State were generally comparable to the national averages but increased over time in WA compared to a decrease over time nationally.
- An increase in turnover rates for nursing staff was associated with a worsening of a range of quality measures in U.S. NHs.
- Registered Nurse (RN) turnover had a greater impact on worsening quality measures than Licensed Practical Nurse (LPN) and Nursing Aide (NA) turnover.
The quantitative analysis used publicly available data from the Centers for Medicare and Medicaid Services, including risk-adjusted quality measures for short-term care (STC) patients and long-term care (LTC) residents from NH Provider files and detailed NH staffing data from the Payroll Based Journal file. Outcomes and turnover rates were analyzed across two one-year periods: between the third quarter of 2022 (2022Q3) and the second quarter of 2023 (2023Q2) and between the third quarter of 2023 (2023Q3) and second quarter 2024 (2024Q2). Across both study years, outcomes were generally better in WA State NHs compared to national averages, except for STC Emergency Departments (ED) visits, which were higher on average in WA State compared to national trends for both study years. LTC use of antipsychotics in WA State NHs also exceeded the national average in the second study year. Between 2022Q3 and 2023Q2, average quarterly turnover rates for all nursing staff combined were similar in WA State compared to the national average. However, while national turnover rates declined in 2023Q3-2024Q2 compared to the prior year, turnover increased in WA state for all nursing disciplines.
Among all U.S. NHs between 2022Q3 and 2024Q2, higher nursing staff turnover was significantly associated with worse outcomes for LTC hospitalizations, LTC ED visits, STC readmissions, STC ED visits, and LTC pressure ulcers, when accounting for other facility characteristics including nursing staff levels. Specifically, a 5-percentage point higher average turnover for all nursing staff combined was associated with a relative 0.7% increase in LTC hospitalizations, 2.7% more LTC ED Visits, 0.7% more STC readmissions, 1.7% STC ED Visits, and 0.4% more LTC pressure ulcers. Nursing staff turnover was not statistically significantly associated with LTC use of restraints, LTC falls, or LTC use of antipsychotics. When examining turnover for specific nursing disciplines across U.S. NHs, higher turnover of RNs had larger associations with worse outcomes compared to turnover of LPNs and NAs.
Authors:
Prusynski RA, Mroz TM, Smith DJ, Dula C, Frogner BK
Journal/Publisher:
Washington State Workforce Technical and Education Coordinating Board
Edition:
Mar 2026.
Funder:
Washington State Workforce Technical and Education Coordinating Board
Link to Article
Access the article here: Washington State Workforce Technical and Education Coordinating Board
Documents:
Citation:
Prusynski RA, Mroz TM, Smith DJ, Dula C, Frogner BK. An assessment of the long-term care workforce services in the state of Washington Part 1: A quantitative analysis. Washington Workforce Training and Education Coordinating Board. Mar 2026.