CMS to Post Nursing Home Staff Turnover and Weekend Staffing Levels

Mary Madison, RN, RAC-CT, CDP 
Clinical Consultant – Briggs Healthcare

CMS posted QSO-22-08-NH late Friday afternoon, January 7, 2022.

“Staffing in nursing homes has a substantial impact on the quality of care and outcomes residents experience. For more than ten years, CMS has been posting information on facility staffing measures on the website Nursing Home Compare (now known as Care Compare), 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. Over the last several years, CMS has made several improvements to the information reported, most notably, transitioning to using data electronically submitted through the Payroll-Based Journal (PBJ) system, as required under section 1128I(g) of the Social Security Act (the Act) and 42 CFR §483.70(q).

After the transition to the use of PBJ data, CMS continued to implement enhancements to the information posted on the Care Compare website and used in the Nursing Home Five Star Quality Rating System. For example, due to concerns related to low staffing on weekends, in November 2018, CMS began identifying facilities with reported low weekend staffing to state agencies and requiring state agencies to conduct surveys in a portion of these facilities on weekends (see QSO 19-02-NH). Also, in April 2019, CMS encouraged facilities to improve their staffing by adjusting the staffing rating’s methodology by adding new thresholds for staffing levels and to increase the weight registered nurse (RN) staffing has on the staffing rating (see QSO 19-08-NH).

The information announced in this memorandum further enhances the information available to consumers, residents, and families to help support their healthcare decisions and incentivizes quality improvement among nursing homes.”

The 5-page QSO goes on to address:

  • Weekend Nurse Staffing
  • Nursing Home Staff Turnover

For example, preliminary (unadjusted) analysis indicates that lower RN, total nurse, and administrator turnover are associated with higher Five Star Ratings. The below figure shows that the average turnover decreases as overall star ratings increase, suggesting that lower turnover is associated with higher overall quality (see Figure 1).

The technical specifications for weekend staffing and staff turnover measures will be included in the Five Star Rating System Technical Users’ Guide on January 14, 2022.

  • Posting Additional Staffing Data

“While the current staffing data posted allow stakeholders to conduct a variety of analyses, it does not include the level of detail that would enable stakeholders to analyze staff turnover. Specifically, it does not include the employee-level data that are needed to identify when a staff member begins and ends work at a facility. Therefore, CMS will be posting the employee-level staffing data in January 2022 for stakeholders to conduct their own analysis to help improve nursing home staffing.

The employee-level data will be posted in the PBJ section of on January 26, 2022. Additionally, CMS will add the measures of turnover and weekend staffing to the facility-level files posted on the Provider Data Catalog, in the section for “Nursing homes including rehab services.”

  • Linking Employee Identifiers

The QSO closes with:

“CMS recognizes that each resident, family, or individual seeking nursing home care has their own specific needs and goals. The Care Compare website and Nursing Home Five Star Quality Rating System are one source of information about nursing homes, but individuals should seek other sources as well. For example, we encourage families to visit facilities and speak to the administrator, other staff, current residents, or the family or resident councils. Through a variety of sources, consumers can find the nursing home that is most suited for their needs or the needs of a loved one.

Improving nursing home staffing is a top priority for CMS. There are many different factors that impact how nursing homes are staffed, and the PBJ program aims to help us understand these factors, how nursing homes are staffed, and how staffing relates to nursing home quality. This information can then be used to inform future actions aimed at improving staffing to protect and enhance the health and safety of nursing home residents.”

Please share this QSO information with your team and colleagues. I’ll post the updated Five Star Rating System Technical Users’ Guide later this week in a BNN Blog when it’s available as well as the employee-level data from the PBJ section on January 26, 2022.

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