CMS Makes Nursing Home Staffing Data Available
Last week, the Centers for Medicare & Medicaid Services (CMS) began posting, for the first time ever, staff turnover rates and weekend staff levels for nursing homes on the Medicare.gov Care Compare website.
CMS calculates staff turnover as the percent of nursing staff and number of administrators that stopped working at a nursing home over a 12-month period. The nursing staff included in this measure includes licensed nurse staff—i.e., registered nurses (RNs); licensed practical and vocational nurses; as well as nurse aides who work under the direction of licensed nurse staff and provide much of the day-to-day care for nursing home residents such as eating, bathing, grooming, and toileting. Weekend staffing is the level of total nurse and RN staffing on weekends provided by each nursing home over a quarter.
CMS has explored the relationship between staff turnover and quality of care and a preliminary analysis indicates that as the average staff turnover decreases, the overall star ratings for facilities increases, suggesting that lower turnover is associated with higher overall quality.
“CMS has long identified staffing as a vital component of a nursing home's ability to provide quality care, and CMS has used staffing data to more accurately and effectively gauge its impact on quality of care in nursing homes,” said CMS Administrator Chiquita Brooks-LaSure. “The COVID-19 pandemic has highlighted the importance of staffing for the well-being of residents and it's more important now than ever that CMS release any information related to staffing that can improve quality. Residents and their families will also find this information valuable as they consider a nursing home for themselves or a loved one.”
Facilities with lower nurse turnover may have more staff that are familiar with each resident’s condition and may be more able to identify a resident’s change in condition sooner. The facility may be able to implement a plan to avoid an adverse event, such as a fall, for a patient. Lower administrator turnover may have a positive impact on leadership stability, direction and operations, which may help staff provide more care consistently and effectively to residents. For more than 10 years, CMS has been posting information on facility staffing measures on the Medicare.gov website, including the average number of hours worked reported for nursing staff per resident per day. These staffing measures are also used to calculate each nursing home’s star rating for the staffing rating domain as part of the Nursing Home Five Star Quality Rating System.
Posting this new information will not create any additional reporting requirements for nursing homes. There is nothing new that nursing homes need to do or report. CMS is using the same data that facilities have been reporting since 2016, as part of the Payroll-Based Journal (PBJ) program. The data is submitted to CMS electronically, and most nursing homes export their data directly from their automated time-keeping or payroll systems.
The Society is currently reviewing this data and encourages all members to review their data. The Society continues to work with CMS to improve transparency around medical direction information. Despite previous requests, CMS has not made any public information available in terms of medical director education, training, or hours spent in the facility. The Society believes this information is vital to consumers and therefore must be included on the Care Compare website.
To review the CMS guidance memo about Nursing home Staff Turnover and Weekend Staffing Levels, please review this document.