CMS Enhances Nursing Home Rating System with Staffing and Turnover Data

Updates to Five-Star Quality Rating System Will Increase Transparency and Improve Quality in Nursing Homes

The Centers for Medicare & Medicaid Services has launched its enhanced Nursing Home Five-Star Quality Rating System which integrates data nursing homes report on their weekend staffing rates for nurses and information on annual turnover among nurses and administrators. The updated Star Ratings increase transparency in support of the Biden-Harris Administration’s commitment to improving the quality of nursing homes so nursing home residents receive the reliable, quality care they deserve.

“Research and experience tell us that staffing levels and staff turnover can substantially affect quality of care and health outcomes for people living in nursing homes,” CMS Administrator Chiquita Brooks-LaSure said. “This enhancement to the Five-Star Quality Rating System helps to better inform consumers and residents about the care each nursing home provides and encourages nursing homes to improve the staffing of their facilities to foster better outcomes for residents.”

CMS research shows that higher nurse turnover is associated with lower quality of care. Nurses who have worked at a facility longer are more likely to know residents well enough to recognize small health changes and act before they become larger issues. Similarly, administrators with longer tenures help create stable leadership which can lead to more consistent policies and protocols that are tailored to better serve residents.

In January, CMS began posting weekend staffing and turnover rates on Medicare’s Care Compare website. With today’s announcement, the agency is now incorporating that information into the consumer-friendly Nursing Home Five-Star Quality Rating System. Through this enhancement, CMS will hold facilities to a higher standard and incentivize more robust staffing by strengthening personnel’s impact on overall star ratings. 

The new nurse staffing information includes registered nurses, licensed practical nurses, vocational nurses and nurse aides who work under the direction of licensed nurse staff and provide much of the day-to-day care for nursing home residents, such as eating, bathing, grooming and toileting. 

Ratings are updated quarterly. A summary of the changes to the methodology can be found in this Fact Sheet, and the details of the methodology can be found in the Five Star Rating Technical Users’ Guide.