CMS Enhances Nursing Home Rating System with Staffing and Turnover Data

Updated: Oct 6


On July 27, 2022, The Centers for Medicare & Medicaid Services (CMS) announced the launch of 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. The updated Star Ratings increase transparency as part of the current administration’s commitment to improving the quality of nursing homes so nursing home residents receive the reliable, quality care they deserve.


Staffing in nursing homes has a substantial impact on the quality of care and outcomes residents experience. For more than 10 years, CMS has been posting information on facility staffing measures on the Medicare.gov website Care Compare. Over the last several years, CMS has made improvements to the information reported. In January, CMS began posting new weekend staffing and staff turnover measures on Care Compare. Now, they are adding four new measures to the Nursing Home Five Star Quality Rating System.


In addition to existing staffing measures for registered nurse (RN) and total nurse hours per resident per day, the new staffing domain rating methodology will include the following measures:

  1. Total nurse (RN, licensed practical nurses, and nurse aids) staffing hours per resident per day on weekends.

  2. Total nurse staff turnover within a given year.

  3. RN turnover with a given year.

  4. Number of administrators who have left the nursing home within a given year

A facility’s performance on each measure is converted to points, which are then totaled and compared to thresholds for each staffing star rating. Similar to the staffing methodology that was implemented in April 2019, the new rating system will use staffing levels of nursing homes with high performance on the quality measures related to hospitalizations to set the five-star staffing rating threshold. The remaining thresholds will then be assigned to produce the four remaining groups (1 to 4 stars). Rating thresholds will be set based on this initial distribution but remain static over time to allow providers to demonstrate improvement.


Additionally, to emphasize the importance of staffing, CMS will no longer add one star to the overall rating of facilities that have a four-star staffing rating. Rather, only facilities with a five-star staffing rating will result in an increase in their overall star rating by the addition of one star.


These changes will provide a more comprehensive representation of each facility’s staffing for residents, families, caregivers, and consumers that use the Care Compare website to view information about nursing homes to support health care decisions for themselves or someone they care about. These changes seek to incentivize a more holistic approach to improving nursing home staffing, and ultimately aim to result in better quality of care and outcomes for residents.


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. With today’s announcement, 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.


Will this update in the 5-star rating system result in any measurable impact on care? “We will have to wait and see,” said Elder Care Coordinator Pati Bedwell. “There has been so little change to the nursing home regulations, and usually the changes that happen have little impact on the care residents receive. That said, I am a little more optimistic about the staffing impact on the star rating. Knowing that a facility cannot get a star added to their overall rating unless they score a 5 in staffing has the potential to truly impact staffing. It may push facilities to increase their staffing numbers, pay, etc. For Middle Tennessee, it means there will no longer be 5-star facilities so, I think, facilities will rush to be the first and only 5-star facility in the area.”


Takacs McGinnis Elder Care Law will keep you posted on the impact of these changes. If you have any questions, please call the office at 615.824.2571.

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