Medicare Ratings Fall for Short-Staffed Nursing Homes- One-Third of Nursing Homes See Ratings Drop

Aging in Place as a discreet planning objective is well justified and documented. Recent improvements to government reporting of data regarding quality of care at nursing homes, while welcome, only underscore the benefits of Aging in Place planning.

According to Kaiser Health News (KHN), the Centers for Medicare & Medicaid Services (CMS), gave its lowest star rating for staffing, one star on its five-star scale, to 1,638 homes, in its update to Nursing Home Compare,  According to a recent KHN article, most nursing homes were downgraded because their payroll records reported no registered-nurse hours at all for four days or more, while the remainder failed to submit their payroll records or sent data that could not be verified through an audit.  KHN characterized the recent action as an "acceleration" in the federal government's "crackdown on nursing homes that go days without a registered nurse by downgrading the rankings of one-tenth of the nation’s nursing homes on Medicare’s consumer website"

According to KHN:

"CMS has been alarmed at the frequency of understaffing of registered nurses — the most highly trained category of nurses in a home — since the government last year began requiring homes to submit payroll records to verify staffing levels. Before that, Nursing Home Compare relied on two-week snapshots nursing homes reported to health inspectors when they visited — a method officials worried was too easy to manipulate." 

CMS announced the changes last March:

"CMS is setting higher thresholds and evidence-based standards for nursing homes’ staffing levels. Nurse staffing has the greatest impact on the quality of care nursing homes deliver, which is why CMS analyzed the relationship between staffing levels and outcomes. CMS found that as staffing levels increase, quality increases and is therefore assigning an automatic one-star rating when a Nursing Home facility reports “no registered nurse is onsite.” Currently, facilities that report seven or more days in a quarter with no registered nurse onsite are automatically assigned a one-star staffing rating. In April 2019, the threshold for the number of days without an RN onsite in a quarter that triggers an automatic downgrade to one-star will be reduced from seven days to four days." 

“Once you’re past four days [without registered nursing], it’s probably beyond calling in sick,” David Grabowski, a health policy professor at Harvard Medical School, told KHN. “It’s probably a systemic problem.”

The American Health Care Association, a trade group for nursing homes, calculated that 36% of homes saw a drop in their ratings while 15% received improved ratings. AHCA has issued a response critical of the changes, and the accuracy and fairness of the ratings. 

KHN has an interactive tool, Look-Up: How Nursing Home Staffing Fluctuates Nationwide.  The tool reveals the rating Medicare assigns to each facility for its registered nurse staffing and overall staffing levels. The tool also shows KHN-calculated ratios of patients to direct-care nurses and aides on the best- and worst-staffed days.  Because staffing is closely related to quality of care, the KHN tool is useful for those investigating, comparing, and evaluating institutional care alternatives.