CMS Strengthens Nursing Home Oversight and Safety to Ensure Adequate Staffing

December 6, 2018
Policy Snapshot

The Centers for Medicare & Medicaid Services (CMS) announced actions that will bolster nursing home oversight and improve transparency in order to ensure that facilities are staffed adequately to provide high-quality care. These actions include sharing data with states when potential issues arise regarding staffing levels and the availability of on-site registered nurses; clarifying how facilities should report hours and deduct time for staff meal breaks; and providing facilities with new tools to help ensure their resident census is accurate.

Research shows the ratio of nurses to residents impacts quality of care and health outcomes. For example, facilities with higher nurse staffing levels tend to have fewer resident hospitalizations. In general, the new payroll-based staffing data shows most facilities have somewhat fewer staff on weekends, but some facilities have significantly lower weekend staffing. Additionally, some facilities have reported days with no registered nurse on-site, although nursing homes are generally required by law to have a registered nurse on-site eight hours a day, seven days a week.   

To help address these risks, CMS will use frequently-updated payroll-based data to identify and provide state survey agencies with a list of nursing homes that have a significant drop in staffing levels on weekends, or that have several days in a quarter without a registered nurse on-site.  State survey agencies will then be required to conduct surveys on some weekends based on this list. If surveyors identify insufficient nurse staffing levels, the facility will be cited for noncompliance and required to implement a plan of correction.

These oversight initiatives are part of broader efforts CMS has underway to strengthen safety and health outcomes for nursing home residents. For example, the Nursing Home Compare website and facility Star Ratings are key resources CMS provides to increase transparency into nursing home quality and help consumers and their caregivers make informed decisions.

CMS also operates the National Partnership to Improve Dementia Care in Nursing Homes, which is helping to reduce the inappropriate prescribing of antipsychotic drugs among nursing home residents, and the recently-launched Civil Money Penalty Reinvestment Program, a three-year initiative to improve residents’ quality of life by equipping nursing home staff, management, and stakeholders with practical tools, education, and assistance to enhance care.

The Civil Money Penalty Reinvestment Program (CMPRP) competency assessment poses questions about behavioral, technical, and resident-based competencies. Use the assessment to identify areas where your nursing home is doing well, versus where your facility might need support.

Toolkit 1 includes:

  • Competency assessments
  • Instruction Manual with resources
  • Answer sheets

Once you know where you need support, CMPRP can provide funding, technical assistance, and learning opportunities to help address some of your facility’s toughest challenges. Visit the CMPRP webpage for more information. Toolkit 1 is available in the Downloads section.