Our experienced nursing home neglect lawyers know that nursing home understaffing creates a significant impact on the quality of care and clinical outcomes for residents. Medicare has now enhanced the information available to residents, families, and the public by adding additional criteria to the Nursing Home Five Star Rating system. Effective January 2022, each nursing home will be required to report additional information regarding weekend nurse staffing and nursing home staff turnover to CMS.

The Centers for Medicare and Medicaid Services (CMS) has posted facility staffing information on the Medicare.gov website for more than a decade. This information includes the average daily hours of work for nursing staff at the facility per resident. The staffing hours then are reflected on the facility’s Nursing Home Five Star Quality Report on a 1 through 5 scale. With the new reporting requirement, nursing home weekend staffing and turnover will be included as part of this rating system.

CMS has long held concerns about nursing home understaffing on weekends. Since November 2018, CMS has identified facilities with low weekend staffing and mandated state agencies to conduct recertification surveys on weekends for some of communities.  In August 2020, the Office of Inspector General (OIG) recommended that CMS provide more information alerting consumers to fluctuations in the daily staffing levels of a nursing home. The OIG cited that seven percent of nursing homes understaffed based on federal requirements for more than 30 days in 2018. Moreover, 65% of nursing home understaffing dates fell on weekends. This variation of staffing on weekends is unacceptable and allows an unnecessary risk of injury, such as falls and pressure ulcers, for elderly nursing home residents.

In January 2022, CMS began publishing data about the level of registered nurse (RN) staffing on weekends on Care Compare. Additional information on overall nurse staffing, to include registered nurse (RN), licensed practice nurse (LPN), and certified nursing assistant (CNA) staffing levels, is also available. This data will be included in the calculation of the staffing rating portion of the facility’s Nursing Home Five Star Quality report effective July 2022.

CMS is also scrutinizing nursing home staff turnover and its impact on quality of care. Some data points suggest that lower RN, total nurse, and Administrator turnover are associated with higher Five Star Ratings for nursing homes. It’s hypothesized that facilities with lower direct care staff turnover may have more staff who are familiar with both the residents’ clinical conditions and the policies and procedures of the facility. In turn, this knowledge can help the facility operate more efficiently and provide better quality of care to residents.  Similarly, nursing homes with lower Administrator turnover may have more consistent leadership and operational oversight leading to higher quality care.

In January 2022, CMS started publishing turnover data that included:

1. Percent of RNs that left the facility over last year
2. Percent of total nurse staff (RN, LPN, CNA) that left the facility over the last year
3. The number of Administrators that left the facility over the past year.

These measures will impact the staffing domain of the Nursing Home Five Star Quality Rating System in July 2022.

The Pennsylvania Nursing Home Injury Lawyers recognize that nursing home understaffing and excessive turnover have resulted in serious injuries and avoidable poor outcomes for residents of Pennsylvania and New Jersey nursing homes. We support the additional reporting requirements that CMS has implemented to provide transparency to consumers about nursing home understaffing and turnover.