WASHINGTON – Shining a light on key markers for nursing home quality, Medicare said Wednesday it is now posting details on staff turnover and weekend nurse coverage on its “Care Compare” website, where families can research a facility.
The move by the Biden administration comes as COVID-19 cases and deaths at nursing homes have risen again, despite extensive efforts to vaccinate residents and staff. Staffing is a critical factor in nursing home quality and safety, but a major upgrade of federal requirements is stuck in Congress, bogged down with the rest of President Joe Biden's sweeping social and climate legislation.
To find the new information, consumers must go to the Care Compare website, select a particular nursing home, and then click on “View Staffing Information.” On that page, they'll scroll down the list to find nurse staffing details on the weekends, and below that, information on turnover for nurses and administrators.
The Centers for Medicare and Medicaid Services, or CMS, said it has researched the links between staff turnover and quality of care. Initial results suggest that as staff turnover decreases, the overall quality rating for a facility increases. Nurse turnover is defined as the percent of nursing staff that stopped working at a facility over a 12-month period. Starting this summer, the agency will use the information on staff churn to help calculate its quality ratings for facilities, which are based on a five-star system.
“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," agency administrator Chiquita Brooks-LaSure said in a statement. "Residents and their families will also find this information valuable as they consider a nursing home for themselves or a loved one.”
Nursing homes succeed or fail based on the quality of personal attention they provide to each individual resident.
Medicare said facilities with lower nurse turnover may have more staff familiar with each resident and may be more quickly able to identify telltale changes in a patient's condition that could signal trouble. For example, the nursing home may be able to put a plan into place to keep a patient who's dragging her feet from falling and suffering a potentially life-changing injury.
Medicare said it's also reporting turnover among administrators because that can affect stability, leadership and day-to-day operations, factors that translate to support for the staffers caring for patients.
Medicare's action drew praise from a a nationally known advocate for raising the bar on nursing home quality.
“Workforce is the number one issue facing nursing homes and transparency about staffing is critical to the safety and well-being of residents,” said Terry Fulmer, president of the nonprofit John A. Hartford Foundation, which works to improve care for older adults.
But one of the main nursing home industry groups called the agency's action “tone deaf.” The American Health Care Association said in a statement the government should instead address a labor shortage leaving many direct care jobs unfilled. “We’ve repeatedly called for help, yet no meaningful aid has been sent to the frontlines,” the group said. “We need public health officials to do more than acknowledge these challenges, but stand up to address them.”
Medicare said posting the new information for consumers will not create additional paperwork burdens for nursing homes. The data is already regularly reported to the government; it just hasn't been easily accessible to the public.
The Biden social agenda bill pending in Congress would require nursing homes to have a registered nurse on duty 24 hours a day, seven days a week. It would also set in motion a process that could lead to federal staffing requirements for nursing homes. Those proposals have set off a lobbying war: The nursing home industry says facilities have a hard enough time keeping current staff while consumer groups argue that minimum staffing requirements are essential steps to better quality.