Medicare Slashes Star Ratings for Staffing at 1 in 11 Nursing Homes

Medicare has lowered its star ratings for staffing levels in one out of 11 of the nation’s nursing homes — almost 1,400 of them — because they were either inadequately staffed with registered nurses or did not provide payroll data that proved that they had the specified nursing coverage, federal records released in the week show.

Medicare only recently began collecting and publishing payroll data on the staffing of nursing homes as needed by the Affordable Care Act of 2010, instead of relying because it had before on the nursing homes’ own unverified reports.

The payroll records revealed lower overall staffing levels then the homes had disclosed, particularly among registered nurses.

Those are the highest-trained caregivers required to be during a home, and that they supervise other nurses and aides.

Medicare mandates that each facility have a RN performing at least eight hours a day.

“It’s a true positive that they really are taking the payroll-based system seriously, that they’re using it to punish that nursing homes that either isn’t reporting staffing or people who are below the federal limit,” said David Grabowski, a professor of health care policy at Harvard school of medicine. 

“Could they be doing more? Sure, but I feel it’s a very good start.”

The five-star scoring system may be a tool for families checking out nursing homes, and therefore the rankings are published on the government’s home Compare website.

The revised ratings gave a rock bottom rating for staffing to 1,387 of the nation’s 15,616 skilled nursing facilities, consistent with a Kaiser Health News analysis of the newest data released by Medicare.

All of they received one star out of a possible five on July 25, when Medicare updated the ratings.

Nursing home industry officials have acknowledged that some facilities are struggling to satisfy the new payroll reporting requirements.

Katie Smith Sloan, president of LeadingAge, an association of nonprofit providers of aging services including nearly 2,000 nursing homes, said the lowered star ratings were disappointing and attributed them largely to a piece force shortage.

“Our members are battling on multiple fronts to recruit and retain all kinds of qualified staff, and nurses especially,” she said during a statement.

In footnotes on the home Compare website, Medicare said the homes with the one-star staffing rating either lacked an RN for “a high number of days” over three months, provided data the govt couldn’t verify or didn’t supply their payroll data in the least.

The downgraded homes reported seven or more days with none registered nurses, the analysis found.

For roughly half the homes, the downgrades lowered their overall star ratings, which are the measures displayed most prominently on the location.

But a number of the homes saw their overall ratings stay an equivalent or maybe rise, buoyed by their scores on other quality measures. Seventy-nine are still rated with a coveted five stars.

While the Kaiser Health News analysis found substantially lower average staffing of nurses and aides at for-profit facilities than at nonprofits and government-owned homes, the number of downgraded nursing homes was roughly proportionally divided among the three categories, indicating the industry-wide issue with staffing by registered nurses especially.

Medicare concedes that because the payroll system is geared toward reporting hourly work, salaried staff might not always be reflected correctly, especially if they were working overtime.

But Medicare had warned the nursing homes in April that the downgrades would be coming if facilities continued to point out no registered nurses on duty.

The agency noted it's been preparing nursing homes since 2015 for the new payroll system.

“We’ve just begun to leverage this new information to strengthen transparency and enforcement with the goals of improved patient safety and health outcomes,” the Centers for Medicare & Medicaid Services said during a statement.

The payroll data, analyzed by Kaiser Health News, showed that for-profit nursing homes averaged 16 percent fewer staff than did nonprofits, even after accounting for differences within the needs of residents.

The most important difference was within the number of registered nurses:

At the typical nonprofit, there was one RN for every 28 residents, but at the typical forprofit, there was just one RN for every 43 residents.

Researchers have repeatedly found lower staffing in for-profit facilities, which structure 70 percent of the industry.

The data also revealed that nursing homes have large fluctuations in staffing. the typical home had one licensed nurse caring for as few as 17 residents or as many as 33, counting on the day.

On the best-staffed days, each certified nursing assistant or other aide cared for nine residents, but on the worst-staffed days, each aide was liable for 16 residents.

Weekend staffing was particularly sparse. On weekends on average, there have been 11 percent fewer nurses providing direct care and eight percent fewer aides.