Fact Sheets

Updates to the Care Compare Website July 2022

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, we began posting new weekend staffing and staff turnover measures on Care Compare (CMS memorandum QSO 22-08-NH). Now, we are adding four new measures to the Nursing Home Five Star Quality Rating System effective with the July 27 release. We also note that improving nursing home staffing and increasing transparency are key components of the White House Fact Sheet on improving nursing home quality and safety.

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:

• Total nurse (RN, licensed practical nurses, and nurse aids) 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

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, we 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.

The changes in the staffing domain described above will change many facilities’ staffing and overall star ratings. Facilities will receive a preview of their ratings in their July Provider Preview report that includes guidance on where to direct questions. For questions related to the new methodology or ratings, facilities can follow the instructions in these reports.

Additional details regarding the staffing rating methodology are included in the updated Nursing Home Five-Star Quality Rating Technical Users' Guide.

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