Staff Turnover in Home Health

Over the past decade, payment for home health care services has more than doubled, and its importance has increased with the rise of care coordination and shared savings models. Home health care is also a key component of strategies to reduce institutional long-term care. Home health agencies report high turnover rates – over 21% on average – that challenge their ability to deliver high quality services. Nursing turnover accounts for a quarter of total health care industry turnover costs, with the cost of a single nurse turnover often over $100,000. This study will use detailed data from one of the 5 largest home health providers in the US, operating in 30 states, to study factors associated with turnover.

This study will use the most comprehensive analytical dataset available to study nursing turnover in home health, including variables extracted from human resources, payroll data, visit logs, discharge records, physical and mental assessments, care plan, and other patient encounter data.


Key Questions

  • Which factors are the most important predictors of turnover in home health care?
  • Are there differences in turnover predictors for each type of personnel employed in home health?
  • Are there differences in turnover predictors for each source of turnover (e.g., retirement, dissatisfaction with job, relocation)?
  • Are there regulatory and policy variables that affect turnover (e.g., scope of practice regulations)?


Journal Article

Bergman, A, Song, H, David, G, Spetz, J, Candon, M. The Role of Schedule Volatility in Home Health Nursing Turnover. Medical Care Research and Review. First online July 26, 2021.



Despite considerable research on nursing turnover, few studies have considered turnover among nurses working in home health care. Using novel administrative data from one of the largest home health care organizations in the United States, this study examined turnover among home health nurses, focusing on the role of schedule volatility. We estimated separation rates among full-time and part-time registered nurses and licensed practical nurses and used daily visit logs to estimate schedule volatility, which was defined as the coefficient of variation of the number of daily visits in the prior four weeks. Between 2016 and 2019, the average annual separation rate of home health nurses was over 30%, with most separations occurring voluntarily. Schedule volatility and turnover were positively associated for full-time nurses, but not for part-time nurses. These results suggest that reducing schedule volatility for full-time nurses could mitigate nursing turnover in home health care.

For more information, contact Joanne Spetz.