Homes with higher nursing staff turnover also had higher long-stay emergency-department use. In the adjusted 2025 model, ten percentage points more turnover was associated with 0.122 more ED visits per 1,000 resident-days.
The raw rank correlation was 0.239 across 10,462 homes in 2025. In 2024, it was 0.216 across 10,722 homes. The chart groups homes into fixed turnover bands; it describes the data and does not estimate a causal effect.
For 2025, average ED-use rates rose from 1.389 visits per 1,000 resident-days among homes below 30% turnover to 2.250 among homes at 60% or more. The five bands contained 1,483; 2,373; 2,853; 2,153; and 1,600 homes, respectively. Each home receives equal weight.
The adjusted model included 9,218 homes and controlled for state, facility size, occupancy, case mix, Medicaid share, urban location, ownership, chain status, and total staffing hours from Payroll Based Journal data. The estimate per ten percentage points of turnover was 0.122, with a 95% state-clustered confidence interval of 0.096–0.149.
This is not a claim that reducing turnover would prevent that many visits. Turnover and ED use were measured during the same year. Resident needs, staffing difficulties, local labor markets, and financial resources could influence both. State-clustered uncertainty also does not capture every dependence within chains operating across states.
Emergency visits can be necessary and appropriate. The association is a reason to investigate staffing continuity alongside outcomes, not a basis for judging an individual home or patient from turnover alone.
The annual panel was rebuilt from CMS ratings and claims files and eight quarters of daily staffing records. Repeated releases were deduplicated by care period, and missing outcomes were excluded. This finding was selected from the full screen of 72 correlations and 36 adjusted models.
Analysis completed November 5, 2026, with AI-assisted coding and writing. Exploratory facility-level research.