The Centers for Medicare and Medicaid Services (CMS) recently announced that it will add data on staff turnover rates and weekend staffing levels to its Care Compare website, giving consumers another tool when choosing a nursing home. The official Medicare website, previously called Nursing Home Compare, offers up to five-star ratings of nursing homes based on health inspections, staffing, and quality measures. Users can search for nursing homes by location and directly compare one institution to another.
CMS will post the following additional information for each nursing home on its website:
- Weekend Staffing: The level of total nurse and registered nurse staffing on weekends provided by each nursing home over a quarter.
- Staff Turnover: The percent of nursing staff and number of administrators that stopped working at the nursing home over a 12-month period.
CMS will begin adding the information to the Care Compare website in January, but the information will not be incorporated into the rating system until July 2022.
The staffing information could not come at a more meaningful time. Nursing homes are plagued by chronic understaffing and high turnover rates. The problem has existed for years, but is exacerbated by the COVID-19 pandemic. A study reported in Health Affairs found that the turnover among nursing staff was 94 percent in 2017 and 2018 and mean turnover rates were as high as 140.7 percent among registered nurses, 129.1percent among certified nursing aides and 114.1 percent among licensed practical nurses.
CMS previously noted a relationship between turnover and ratings. CMS noted in a memo that:
"facilities with lower nurse turnover may have more staff that are familiar with each resident’s condition and may therefore be more able to identify a resident’s change in condition sooner. In doing so, the facility may be able to implement an intervention to avoid an adverse event, such as a fall, acute infection, or hospitalization, which are indicators of quality. Similarly, facilities with lower nurse turnover may be more familiar with the facility’s policies and procedures and can potentially operate more efficiently and swiftly to deliver a higher quality of care to residents. Lastly, facilities with lower administrator turnover may have greater leadership stability, direction, and operations, which may help staff provide care more consistently or effectively to residents."
Regardless of the reasons for the association between turnover and quality, CMS acknowledging the relationship is encouraging.
CMS has also acknowledged that the additional information is important and is thus valuable to consumers. For example, regarding weekend staffing, CMS acknowledged that consumers may not realize that nursing home staffing levels can vary on weekends. CMS hopes to encourage facilities to hire more weekend staff by adding weekend staff numbers to the nursing home rating system.
The fundamental underlying question, though, is whether adding additional information will help transform a questionable and unreliable system into a more meaningful system for consumers. There is good reason to remain skeptical; there are numerous reports and examples suggesting that the federal ratings are inaccurate or misleading. Consider the following:
- NYT: "Maggots, Rape and Yet Five Stars: How U.S. Ratings of Nursing Homes Mislead the Public;
- Nursing Homes Create Phony Diagnoses to Sedate Patients with Dangerous Drugs, Doubling Risk of Death;
- Nursing Home Compare Does Not Accurately Reflect Patient Safety In Nursing Homes;
- Half of Most Dangerous Nursing Homes Remain Treacherous for Residents After Homes Are Cleared By Regulators.
“I do think longer term this data will add value and can serve as a signal to all of us that we need to invest more in direct care staff. We get the turnover we pay for and since we aren’t paying enough, we’re seeing high turnover. That’s not something nursing homes can fix on their own. I really believe we need more reimbursement from Medicaid and Medicare to make that happen.”
