A nursing home worker smiling and helping residents
Credit: Morsa Images/Getty Images Plus

Nursing home staff turnover rates and weekend staffing levels can now be viewed publicly on the Care Compare website, the Centers for Medicare & Medicaid Services announced Wednesday. 

The decision, though well-intentioned, could not have come at a worst time for many nursing homes who are already struggling with severe staffing shortages exacerbated by the pandemic, many provider advocates say.

“While we support transparency and agree that staffing hours and turnover metrics are important, more reporting will not solve this issue,” the American Health Care Association said in a statement Wednesday. “The addition of these metrics on Care Compare when we are in the middle of the worst labor shortage the nursing home sector has ever faced is tone deaf.” 

The association added that it has “repeatedly called for help, yet no meaningful aid has been sent to the frontlines. We need public health officials to do more than acknowledge these challenges, but stand up to address them.” 

LeadingAge, in a letter to CMS Tuesday, called on the agency to delay the implementation until the end of the public health emergency. 

“The addition of these metrics on Care Compare when we are in the middle of the worst labor shortage the nursing home sector has ever faced is tone deaf.”

The American Health Care Association

CMS first announced the decision to go public with the information earlier this month in an effort to help consumers looking for a nursing home for a loved one. The agency also will begin incorporating the data into the Five Star rating system starting in July.

Providers have been required to report staffing data since 2016 as part of the Payroll-Based Journal (PBJ) System. CMS said Wednesday the new postings would not create any additional reporting requirements for nursing homes. 

“The COVID-19 pandemic has highlighted the importance of staffing for the well-being of residents and it’s more important now than ever that CMS release any information related to staffing that can improve quality,” CMS Administrator Chiquita Brooks-LaSure said in a statement.

Staff lured away 

While providers appreciate CMS’ efforts to increase transparency, they are concerned about the timing to publicly report the measures, said Amy Stewart, vice president of education and certification strategy for the American Association of Post-Acute Care Nursing. 

“The results are reflective of the ill-effects of the pandemic and not necessarily a true reflection of a facility’s ability to attract and retain staff under normal circumstances,” Stewart told McKnight’s Long-Term Care News Wednesday. “The pandemic has caused many people to leave healthcare for a myriad of reasons.” 

She noted that skilled nursing facilities aren’t the only healthcare providers struggling with staffing. That increases the difficulty in not only recruitment efforts but retention, as well. 

“There are many providers offering incentives to attract new staff and current SNF staff may be lured to these other settings,” Stewart said. 

‘Kick us while we’re down’

CMS recently began sharing the staff turnover and weekend data confidentially to providers and has also recently shared details about the technical details of the calculations, according to Robin Hiller, CPA, of RLH Consulting. She believes some providers have been motivated to start thinking differently about how they utilize their administrative nursing staff differently throughout the week.

“I do not think that it is helpful to the profession to begin publicly reporting this data in the midst of the greatest staffing shortage the profession has ever faced, especially in light of the vaccine mandate soon to take effect, which can potentially exacerbate the staffing shortage even further,” Hiller told McKnight’s Wednesday. 

” … this frankly feels like one more way to kick us while we’re down.”

Robin Hiller

She added that there are concerns about some of the data assumptions being used in the calculations that could make them misleading. She believes more time is needed to vet the information and calculation details before publicly reporting. 

“To the best of my knowledge, CMS has not yet made available to the profession the details of how these new measures would be used in the Five Star rating, and I think even if we weren’t in the midst of the PHE and related staffing crisis, it would be fair to providers to ‘preview’ the new [Five Star] rating results for a period of time (six months to one year) before the new rating would be used publicly,” Hiller urged. 

She added that “with all the profession has gone through in the past three years, and continues to struggle with, this frankly feels like one more way to kick us while we’re down.” 

Welcomed by others 

Consumer advocates are glad to see the information posted on Care Compare and said the move is “long past due” by CMS. 

“These new measures were required as part of the Affordable Care Act and CMS has been working on them for years. This new data provides important information for consumers about the staffing in a facility and how that impacts the quality of care for the residents living there,” Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care, told McKnight’s Wednesday. 

Smetanka said that lower staffing levels often mean residents have to wait longer or don’t receive necessary care and services.  High turnover means that staff are “less likely” to know the residents, recognize changes in condition or implement preferred methods of providing care. All of this contributes to the quality of care residents receive and their quality of life, she said. 

“This information is as important for consumers now as it ever was. These new measures are further evidence that we have a staffing crisis in this country — one that pre-dates the pandemic,” Smetanka said.  

“Not only do we need to implement better policies that support staff, such as providing better pay and benefits and improving working conditions, but we need better accountability for the provider actions that have contributed to this crisis,” she added.