Effective July 27, 2022, the Centers for Medicare & Medicaid Services (CMS) includes weekend staffing rates for nurses and information on annual turnover of nurses and administrators as it calculates the staffing measure for the federal website Care Compare. CMS cites research documenting that staffing levels and staff turnover “‘can substantially affect quality of care and health outcomes for people living in nursing homes.’” Since January 2022, CMS has posted weekend staffing and turnover rates on Care Compare. An analysis reported in McKnight’s Long-Term Care News on July 28 finds that one-third of nursing facilities nationwide declined in their staffing rating as a result of the new methodology, with 939 facilities losing two or more stars.
A companion Fact Sheet to the July 27 Press Release identifies the four new components of the methodology for the staffing measure:
- Total nurse (RN, licensed practical nurses, and nurse aides) staffing hours per resident per day on weekends
- Total nurse staff turnover within a given year
- RN turnover with a given year
- Number of administrators who have left the nursing home within a given year
CMS converts performance on each measure into points, “which are then totaled and compared to thresholds for each staffing star rating.” Additional information is available in CMS’s Technical Users’ Guide for the Five-Star Quality Rating System, which CMS updated in July.
Also effective July 27, CMS no longer adds a star to a facility’s overall rating on Care Compare if the facility has four stars (on a five-point scale) in the staffing domain. Only nursing facilities with five stars in staffing will receive an additional star in their overall rating. Care Compare gives one to five stars in three domains (survey inspections, staffing, and quality measures) and calculates an overall rating, with one star defined as much below average and five stars defined as much above average. When CMS previewed this change to Care Compare on July 7, 2022, various nursing home industry analysts predicted that 10-16% of facilities would no longer see increases in their overall ratings as a result of the change.
July 28, 2022 – T. Edelman
 CMS, “CMS Enhances Nursing Home Rating System with Staffing and Turnover Data” (Press Release, Jul. 27, 2022), https://www.cms.gov/newsroom/press-releases/cms-enhances-nursing-home-rating-system-staffing-and-turnover-data
 See Qing Zheng, Christianna S. Williams, Evan T. Shulman, Alan J. White, “Association between staff turnover and nursing home quality – evidence from payroll-based journal data,” Journal of the American Geriatrics Society (2022)
 Danielle Brown, “1 in 3 nursing homes fall in staffing under new CMS Five-Star rating system,” McKnight’s Long-Term Care News (Jul. 28, 2022), https://www.mcknights.com/news/1-in-3-nursing-homes-fall-in-staffing-under-new-five-star-rating-system/
 CMS, “Updates to the Care compare Website July 2022” (Fact Sheet, Jul. 27, 2022), https://www.cms.gov/newsroom/fact-sheets/updates-care-compare-website-july-2022
 CMS, Technical Users’ Guide for the Five-Star Quality Rating System (Jul. 2022), https://www.cms.gov/medicare/provider-enrollment-and-certification/certificationandcomplianc/downloads/usersguide.pdf
 CMS, “CMS Enhances Nursing Home Rating System with Staffing and Turnover Data”(Press Release, Jul. 27, 2022), https://www.cms.gov/newsroom/press-releases/cms-enhances-nursing-home-rating-system-staffing-and-turnover-data
 CMS, “Updates to the Nursing Home Compare Website July 2022 Updates” (Fact Sheet, Jul. 7, 2022), https://edit.cms.gov/files/document/updates-nursing-home-compare-website-july-2022-updates.pdf
 Kimberly Marselas, “Thousands of nursing homes face lower Five-Star ratings with changes to staffing stars,” McKnight’s Long-Term Care News (Jul. 11, 2022), https://www.mcknights.com/news/thousands-of-nursing-homes-face-lower-five-star-ratings-with-changes-to-staffing-stars/