Nearly 1,400 nursing homes have lost star ratings in Nursing Home Compare staffing levels because of inadequate numbers of registered nurses or from a lack of reporting reliable staffing information, signs of the Payroll-Based Journaling pigeons coming home to roost.
The Centers for Medicare & Medicaid Services updated the ratings on July 25, leaving 1,387 out of 15,616 facilities (nearly 9%) with the lowest ratings for staffing, per a Kaiser Health News analysis.
The biggest surprise in the data related to a lack of registered nurses, given that CMS requires a registered nurse in every facility every day for eight hours a day. The facilities with a one-star staffing rating had a lack of a registered nurse for a “high number of days” over three months, provided unverifiable information to the government or didn’t supply payroll data in any way, Kaiser reported. Downgraded homes had a week or more without any registered nurses, according to the analysis.
While the decline in stars was both anticipated and disappointing, LeadingAge CEO Katie Smith Sloan said it reflects a “workforce crisis” of not being able to find enough staff, particularly nurses.
“Multiple factors, from shifting demographics and a full-employment economy, to our country’s reluctance to adequately fund Medicaid — the primary public source of financing for nursing homes in the U.S. — not to mention societal biases toward aging, make this a particularly knotty problem,” she said in a statement sent to McKnight’s Monday. “Our nonprofit members work hard to develop programs and devise solutions to address these shortages. However, we believe this issue is larger than one, two or one hundred providers.”
The lower rankings doesn’t mean staffing has declined, said David Gifford, M.D., the American Health Care Association Vice President of Quality & Regulatory Affairs.
“While staffing is one of many important metrics in quality care, what really matters are health outcomes and customer satisfaction,” he said in a statement. “The changes to the CMS Five-Star system doesn’t mean that staffing or quality has actually changed in the past several months.”
CMS debuted PBJ in efforts to avoid nursing homes “staffing up” around surveys. Agency officials noted they had been training facilities since 2015 on how to submit the data. While facilities started reporting their data to CMS in July 2016, the Five Star integration was delayed to 2018.
Kaiser’s analysis found that for-profit nursing homes had 16% fewer staff than nonprofits. It also found that for-profits had one registered nurse for every 43 residents, compared to one RN to every 28 residents at nonprofit facilities. On weekends on average, there were 11% fewer nurses providing direct care and 8% fewer aides, Kaiser reported. On the best-staffed days, one certified nursing assistant or aide oversaw nine residents on average, but on the worst-staffed days, an aide was responsible for 16 residents.