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CMS Use of Data on Nursing Home Staffing: Progress and Opportunities To Do More

WHY WE DID THIS STUDY

In April 2018, CMS began updating staffing information on Nursing Home Compare, which was a public website, with a new source for staffing data. In December 2020, CMS moved these data to a new website, called Care Compare, that contains the same staffing information for consumers that Nursing Home Compare did. Specifically, consumers can search nursing homes based on location and compare quality of care and staffing. The usefulness of this information to consumers depends on the extent to which it is complete and accurate.

Additionally, CMS works with State survey agencies to monitor nursing home compliance with Federal requirements, including those for staffing.

HOW WE DID THIS STUDY

We analyzed staffing information reported by nursing homes, conducted in-depth interviews with subject-matter experts at CMS, and reviewed CMS documentation. We also surveyed SSAs to understand how CMS works with them to monitor compliance with nursing home staffing requirements and to identify any gaps in oversight of nursing home staffing. Our period of review was the staffing data from April 1, 2018 to March 31, 2019, but we also included recent CMS actions through December 2020.

WHAT WE FOUND

CMS has taken important steps to build a new source for data on nursing home staffing and to use these data to better inform consumers and improve nursing home oversight. CMS provides the public with some of this staffing information on the Care Compare website. There, consumers can use Staffing Star Ratings to compare nurse staffing between nursing homes. Additionally, CMS has implemented a robust process to ensure the reliability of this nurse staffing information.

However, CMS has opportunities to better use the staffing information that nursing homes report. Specifically, the staffing information that CMS provides on Care Compare could be more useful to consumers if it included data on nurse staff turnover and tenure, as required by Federal law. CMS reported that the COVID-19 pandemic delayed its progress to implement these requirements.

Additionally, CMS can take steps to increase the reliability of the non-nurse staff information (i.e., information on physical therapists) that CMS publicly reports on Care Compare. Non-nurse staff play a critical role in providing quality care.

Further, CMS has taken an important step to target its oversight of nurse staffing by sharing information with State survey agencies. Specifically, to help State survey agencies target weekend inspections, CMS now informs the agencies as to which nursing homes reported lower weekend staffing. However, CMS can take additional steps to improve the effectiveness of State survey agencies' weekend inspections and strengthen oversight of staffing in nursing homes.

WHAT WE RECOMMEND

OIG acknowledges the impact that COVID-19 has had on nursing home oversight and on CMS's priorities to help improve the quality of care that nursing homes provide. We note that the pandemic also reinforces the importance of having adequate staffing to respond to outbreaks of infectious diseases. We recommend that CMS (1) provide data to consumers on nurse staff turnover and tenure, as required by Federal law; (2) ensure the accuracy of non-nurse staffing data used on Care Compare; (3) consider residents' level of need when identifying nursing homes for weekend inspections; and (4) take additional steps to strengthen oversight of nursing home staffing. CMS concurred with all four of our recommendations.