Therapy Staff Turnover in Skilled Nursing Facilities: Facility Characteristics and Associations with Resident Outcomes

This study measured turnover of physical, occupational, and speech therapy staff in skilled nursing facilities (SNFs) from July 2020 through September 2023. We estimated associations between SNF characteristics and high therapy staff turnover and between turnover and therapy-relevant SNF-level patient outcomes. Average quarterly turnover of combined therapy staff was 13.0%, with higher turnover in for-profit SNFs, urban SNFs, and SNFs with lower therapy and nurse staffing and recent ownership changes. Periods of high therapy staff turnover within SNFs were associated with small increases in two adverse outcomes for long-term care residents: increasing need for assistance with activities of daily living and worsening ability to move independently. There was no association between turnover and falls for long-term residents or functional improvement for short-stay patients. Results suggest urban and for-profit SNFs could be targeted in efforts to reduce therapy staff turnover, with the potential for modest improvement in patient outcomes.