My happy place is standing in front of nursing home providers and honoring them through education. Shining a loving light on these special people and honoring their commitment to better care feeds my soul. So when Moshe Kelman asked me to present at his provider organization’s annual educational/holiday conference, I gleefully accepted.
“We want to celebrate our staff through education and honoring them in many ways. They are truly amazing,” Mr. Kelman shared. And I agree.
I was asked to present on “the data deluge”: which metrics matter the most and how to best focus on them. The conference attendees would be a mix of administrative and clinical leadership, along with a diverse group of professionals from each facility. Fun! But as the event approached, I wasn’t certain of the best insights to share. What data or metric should be the focal point?
For years I would have answered this call with Five-Star, but not anymore. Overall Five-Star is too broad to be considered “focused.” My number two choice would have been the many hospital utilization metrics; there are so many of them, and like Five-Star, they hook into pretty much everything in post-acute care — including Five-Star, SNF Value-Based Purchasing (VBP), and, ultimately, occupancy.
Thankfully, I didn’t have to dwell too long in my sea of uncertainty. The Centers for Medicare & Medicaid Services has made it clear what the new focus must be — staffing. Let me make my case.
- President Biden’s remarks and accompanying fact sheet during his State of the Union address on Feb. 28, 2022, indicated that he will establish a new minimum staffing ratio to protect residents.
- In July 2022, CMS enhanced Five-Star by adding staffing metrics that call out weekend staffing and turnover rates.
- Additionally, beginning in July, providers could no longer receive an extra “bonus star” for staffing at a 4-star level.
- On Oct. 21, 2022, CMS revised the Special Focus Facility (SFF) program and made the following statement: “Given the importance of staffing and its relationship to quality, CMS is informing SAs [State Survey Agencies] to consider a facility’s staffing when selecting an SFF. For example, if a SA is considering two SFF candidates with a similar compliance history, CMS recommends selecting the facility with lower staffing.”
- In the FY 2023 SNF PPS final rule, CMS adopted a measure looking at total nurse staffing hours per resident day for the 2026 program year. This measure includes registered nurses, licensed practical nurses, and nurse aides.”
- In that same final rule, CMS sought stakeholder input on other measures under consideration for the SNF VBP Program, including a staffing turnover measure.
These six reasons are why I elected to highlight staffing data/metrics within my “data deluge” presentation. I didn’t need to solely lean into CMS activities to support my choice; a growing body of professional peer-reviewed evidence is making connections between quality outcomes and staffing. The conference participants have done an outstanding job not only in creating these connections at their facilities, but also improving their staffing metrics.
Yet the CMS measures don’t tell the whole story. We have been wrong to focus only on nursing staff. This ongoing mistake has hurt our industry, our residents and their outcomes. The best way to meet the needs of our frail elderly population is through interdisciplinary teams.
The initiatives listed above put too much emphasis on nursing and devalue other disciplines. They disincentivize nursing homes from investing in social workers, recreational therapists, dietitians, physical/occupational/speech therapists, and properly credentialed medical professionals.
Many thanks to my friends in Kentucky and New York for allowing me to speak with your truly inspiring teams!
Steven Littlehale is a gerontological clinical nurse specialist and chief innovation officer at Zimmet Healthcare Services Group.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
