Throughout our many years of experience, we have found the vast majority of nursing home staff to be well-intentioned and hardworking. That said, the Centers for Medicare and Medicaid Services (CMS) have concluded there is room for improvement.

A new, more rigorous data-gathering system for nursing homes that relies on payroll records – not self-reporting as before – is now being implemented to gather information about staffing levels. The new data has revealed wider deficiencies in staffing than previously believed, particularly with regard to registered nurses. Under federal regulations, a registered nurse must be on site for at least eight hours daily; a licensed practical nurse must be present at all times. According to the payroll records, about a quarter of nursing homes surveyed lacked a registered nurse on site at least one day during each three-month period. Based on payroll data, last year Medicare lowered its ratings for about 1,400 nursing homes.

To remedy the situation, CMS is increasing the frequency of surprise spot checks at skilled nursing homes, particularly on the weekends. However, representatives of the nursing home industry argue that increased spot checks do not solve the real problem skilled nursing homes face: a shortage of workers. Dr. David Gifford, senior vice president of quality and regulatory affairs at the American Health Care Association, writes: “CMS seems to be focusing on a punitive approach that will penalize providers and make it harder to hire staff to meet the shared goal of increasing staffing.”
To see how a skilled nursing facility rates, check out the  Nursing Home Compare page on the CMS website. The rating scale is based on a scale of one to five stars, with five being the best. Stars are awarded based on staffing, as well as health inspections and several other quality of care measures.