Latest Insights and Updates

The Centers for Medicare and Medicaid Services (CMS) has announced that it will begin posting nursing home staff turnover rates and weekend staffing levels on its consumer-facing website, Care Compare. This move aims to provide more transparency and information to consumers, residents, and families about the quality of care provided by nursing homes. The data will also be incorporated into the public Five-Star rating system in July.

Researchers have long linked high staff turnover rates with lower star ratings and poor resident outcomes, including infection control issues. A national analysis published in Health Affairs found that mean turnover rates were staggeringly high, with 140.7% among registered nurses, 129.1% for certified nursing aides, and 114.1% among licensed practical nurses. The publication of this data has been a long time coming, with the Affordable Care Act setting statutory requirements for its release.

CMS noted that facilities with lower nurse turnover may be able to identify changes in resident condition more quickly and provide better care. To encourage facilities to increase nurse staffing on weekends, CMS will begin posting data on weekend RN and total nurse staffing levels for all nursing homes on Care Compare. The goal is to put pressure on providers to improve their retention rates and address the needs of their staff.

Industry experts expect this increased visibility into operations to put additional pressure on providers. Residents and regulators will now be able to assess whether a facility is doing a good job retaining its staff, and facilities that want to improve their retention will need to better address the needs of their staff. This may include increasing wages and benefits for tenured staff.

The article discusses the final rule issued by the Centers for Medicare & Medicaid Services (CMS) regarding minimum staffing requirements for nursing homes. The rule requires nursing homes to have a registered nurse on duty at all times and sets minimum staffing ratios for certified nursing assistants.

However, CMS has also established exemption criteria for facilities that are facing hardship in meeting these staffing requirements. To be eligible for an exemption, a facility must demonstrate that it is making good faith efforts to hire and retain staff, but is still unable to meet the minimum staffing requirements due to circumstances beyond its control.

The exemptions will be granted on a temporary basis and will need to be renewed at every recertification survey. Facilities that are found non-compliant with the minimum staffing requirements while not meeting the exclusionary criteria will need to provide documentation of their efforts to hire and retain staff, as well as demonstrate a financial commitment to adequate staffing.

CMS officials emphasized that the exemptions are designed to mitigate any challenges in the near term, but ultimately, all facilities must meet the minimum staffing requirements. The agency is also launching a nursing home staffing campaign, with plans to invest over $75 million to support state efforts to allow nursing homes to meet the minimum staffing requirements.

Industry leaders have expressed concerns that the exemptions may not be sufficient and that the financial incentives offered by CMS may not be enough to address the staffing challenges faced by many facilities. However, CMS officials believe that the final rule provides a balanced approach that promotes safe and high-quality care for residents while considering the current challenges faced by some facilities.

Key points:

• The final rule sets minimum staffing requirements for nursing homes, including a registered nurse on duty at all times and minimum staffing ratios for certified nursing assistants.
• Exemptions will be granted to facilities that demonstrate good faith efforts to hire and retain staff, but are still unable to meet the minimum staffing requirements due to circumstances beyond their control.
• The exemptions will be temporary and will need to be renewed at every recertification survey.
• Facilities found non-compliant with the minimum staffing requirements while not meeting the exclusionary criteria will need to provide documentation of their efforts to hire and retain staff, as well as demonstrate a financial commitment to adequate staffing.
• CMS is launching a nursing home staffing campaign, with plans to invest over $75 million to support state efforts to allow nursing homes to meet the minimum staffing requirements.

The Centers for Medicare & Medicaid Services (CMS) has implemented a staffing mandate for nursing homes, which requires them to meet certain minimum staffing requirements. However, many nursing homes are struggling to meet these requirements due to workforce shortages and survey backlogs. The CMS has established an exemptions process for nursing homes that cannot meet the staffing requirements, but industry experts are expressing concerns about the feasibility of this process.

One of the main issues is that nursing homes must be surveyed and cited for noncompliance before being considered for an exemption. However, with a shortage of surveyors and a backlog of surveys, it can take several years for a facility to receive a survey, making it difficult to obtain an exemption in a timely manner. Additionally, the criteria for exemptions are stringent, including requirements related to geographic location, hiring efforts, and financial commitment.

Industry experts estimate that only a small percentage of nursing homes will be able to meet the exemption criteria, despite CMS estimates suggesting that 22-29% of facilities may be eligible. The American Health Care Association (AHCA) analysis of federal data found that only 6% of nursing homes currently meet all four staffing mandate requirements. Industry leaders are criticizing the exemptions process as unrealistic and impractical, citing fundamental issues with the program.

The implications of survey backlogs on exemptions could be detrimental to access of care for older adults in need of nursing home care. With many providers struggling to meet staffing mandates, some may be forced to limit admissions or close down beds and units, reducing access to care. Industry leaders are calling on CMS to reconsider the staffing mandate and exemptions process to ensure that it is feasible and realistic for nursing homes to comply with the requirements.

Overall, the article highlights the challenges facing nursing homes in meeting the CMS staffing mandate and the limitations of the exemptions process. It emphasizes the need for a more practical and realistic approach to ensuring adequate staffing levels in nursing homes while also considering the complexities of workforce shortages and survey backlogs.

The Centers for Medicare & Medicaid Services (CMS) has waived the deadline to report Payroll-Based Journal (PBJ) data for the second quarter of 2020 due to the COVID-19 public health emergency. Facilities are encouraged to still report their data as they are able, and there will be no penalties or negative impacts to staffing ratings for not submitting by May 15.

As facilities work to gather the necessary information for PBJ submission, there are several key things to remember. One of the biggest reasons skilled nursing facilities (SNFs) are downgraded in the staffing component of the Five-Star rating system is due to lack of Registered Nurse (RN) coverage. Facilities must ensure that they have adequate RN staffing and report accurate data to avoid a downgrade.

Other important reminders include monitoring nurse aide coverage, tracking hours worked by individual employees to avoid overworking or overstating hours, and ensuring weekend coverage for direct care staff. Additionally, facilities must deduct meal break time for all staff and allocate hours for universal care workers who perform multiple duties. It is also crucial to check the PBJ data for reasonability and compare it to the facility's budget and/or actual staffing levels.

The article also notes that CMS has revised the PBJ Data Specifications (Version 4.00.0) and XML files submitted with older versions will be rejected after June 2, 2020. Facilities should check their validation report after submitting their PBJ data and correct any errors before resubmitting.

Overall, it is essential for facilities to carefully review and prepare their PBJ data to ensure accuracy and compliance with CMS regulations. By following these reminders and guidelines, facilities can avoid common pitfalls and maintain a high level of quality care for their residents.