CMS Enhances Nursing Home Rating System with Staffing and Turnover Data

The Centers for Medicare & Medicaid Services launched its enhanced Nursing Home Five-Star Quality Rating System which integrates data nursing homes report on their weekend staffing rates for nurses and information on annual turnover among nurses and administrators.  

CMS research shows that higher nurse turnover is associated with lower quality of care. Nurses who have worked at a facility longer are more likely to know residents well enough to recognize small health changes and act before they become larger issues. Similarly, administrators with longer tenures help create stable leadership which can lead to more consistent policies and protocols that are tailored to better serve residents. 

In January, CMS began posting weekend staffing and turnover rates on Medicare’s Care Compare website. The agency is now incorporating that information into the consumer-friendly Nursing Home Five-Star Quality Rating System. Through this enhancement, CMS will hold facilities to a higher standard and incentivize more robust staffing by strengthening personnel’s impact on overall star ratings. 

The new nurse staffing information includes registered nurses, licensed practical nurses, vocational nurses, and 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. 

Ratings are updated quarterly. A summary of the changes to the methodology can be found in this Fact Sheet, and the details of the methodology can be found in the Five Star Rating Technical Users’ Guide. 

For a fact sheet on the July 2022 Updates to the Care Compare Website, please visit: https://www.cms.gov/newsroom/fact-sheets/updates-care-compare-website-july-2022. 

Issue: 

Facilities must have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to ensure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care and considering the number, acuity, and diagnoses of the facility’s resident population in accordance with the required facility assessment according to F838. 

Discussion Points: 

• Review your new employee orientation process and determine if changes should be made to help retain employees. Discuss with human resources the current tactics that are being used to recruit new employees. In addition, review nursing policies and procedures to ensure that they are comprehensive and competency-based. Update as needed. 
• Train the appropriate staff on the importance of new employee orientation. Also train all nursing staff on your policies and procedures for nursing skills, and ensure that each nurse demonstrates competency in providing care. Ensure that nurses have access to the nursing policies and procedures for easy reference. Ask staff if there are areas within their responsibilities where they would like to receive additional training, and provide the requested instruction. Document that these trainings occurred and file in each employee’s education file. 
• Periodically audit to determine that new staff orientation is complete to ensure competency of the employees filling each role. In addition, periodically conduct audits to ensure that each nurse’s competency is evaluated upon hire and at least annually thereafter per your facility’s policy. Conduct “stay interviews” with current employees to learn why they choose to stay with the facility, and incorporate their suggestions into your staff retention efforts.