In recent years, the Centers for Medicare and Medicaid (CMS) have posted data about the quality of nursing homes on its website. The Five Star Rating System combines information from inspections and the individual information obtained from mandatory, serial assessments through the process known as the Minimum Data Set (MDS). This rating system starts with the health inspections ratings, adding a star if the staffing rating is greater than the health inspections rating or subtracting a star if the staffing was suboptimal. The staffing rating is devised by examining the number of Registered Nurse (RN) hours per resident day as well as the total nursing staffing hours provided by Licensed Practical/Vocational Nurses (LPN/LVNs) and certified nursing assistants (C.N.As) per day. Although the staffing data are submitted by the nursing home to the inspectors, the turnover calculations of the nursing staff are not reported or considered as quality of care determinants.
CMS acknowledges that there are limitations to their data collection primarily due to variations in inspection processes among states and the nature of self-reported quality measures and staffing information reported by the nursing homes.
How do we measure quality in nursing homes? The inspection process focuses on documentation, care planning, the process of medication administration and the compliance with regulations by all the departments. Would a nursing home resident use these same measures when discussing quality of care in this environment? Its more likely that a resident would say that having caregivers who appreciate his need for dependable staff who understand the individual’s preferences and need to direct his care than the whether the nursing home is accurately reporting activities or daily living or the prevention of pressure ulcers.
Is it possible to use the existing data from inspections and the MDS and combine them with the things that are meaningful to residents and their families? If quality measures can also take turnover rates into consideration, would nursing homes then make additional efforts to address the factors that lead to high levels of nursing turnover such as the education, support, supervision and benefits paid to the staff? If we focus on the reasons that nursing staff leave a facility, we should be able to decrease turnover and improve care. Can we encourage nursing homes to focus on methods to address turnover without mandating it or waiting for it to be recognized as a powerful quality of care factor? Let's start now.