The Skilled Nursing News reported a new development from The Centers for Medicare & Medicaid Services (CMS) which recently announced new standards for its consumer-facing nursing home ratings, including a lower threshold for staffing penalties and new separate ratings for short-term and long-term stays.

Starting April 24, CMS will automatically hand out one-star staffing ratings to buildings that have four or more days in a quarter with no registered nurse on site, down from the current seven-day standard.

Nurse staffing has the greatest impact on the quality of care nursing homes deliver, which is why CMS analyzed the relationship between staffing levels and outcomes,” the agency said announcing the new rules for the Five-Star Quality Rating System. “CMS found that as staffing levels increase, quality increases.”

 Staffing issues took center stage in the public discourse around Nursing Home Compare last summer, when the New York Times and Kaiser Health News published an expose on the widespread inflation of nursing home staffing coverage in CMS’s data. In response, CMS slapped nearly 1,400 nursing homes with a one-star rating in the staffing category because they had seven or more days per quarter with no RN hours.

The federal agency also announced in November that it would begin using Payroll-Based Journal data — which replaced nursing homes’ previously self-reported staffing information — to direct state-level inspections of properties deemed to have insufficient staffing.

In addition to these new requirements, CMS will also develop separate quality ratings for short-stay and long-stay residents, and adjust the star thresholds “to better identify the differences in quality among nursing homes, making it easier for consumers to find the right information needed to make decisions.”

While every nursing home resident has their own individual needs and goals, the overarching goal of the short-stay residents is typically aimed at improving their health status so they can return to their previous setting,” CMS wrote in its extended guidance on the new rules. “Conversely, the main goal of long-stay residents is typically aimed at maintaining or attaining their highest practicable well-being while residing long term in the facility.”


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