Medicare Lowers Ratings of 1,400 Nursing Homes due to Staffing Concerns

Medicare has lowered the star ratings of 1,400 nursing homes due to staffing concerns, according to recent reports.  Federal records released in July 2018 showed that the 1,400 nursing homes had failed to provide certain data, or had inadequate staffing as mandated by federal guidelines.

Related to nursing homes, staffing issues are among the biggest concerns for families, lawmakers, and advocates.  When nursing homes are not properly staffed, and records are not properly maintained, it is difficult to determine whether residents are safe.  It is also difficult to determine whether the facility is following regulations.

Read on to learn more about the recent Medicare rating changes.  If you have questions about nursing home safety, protecting your loved ones, or protecting yourself, contact Nursing Home Abuse Center directly to speak with one of our nursing home abuse lawyers.

Medicare Lowers Ratings of 1,400 Nursing Homes due to Staffing Concerns

Medicare uses a five-star rating system to measure the care provided to residents, and the facilities’ compliance with regulations.  In the area of staffing registered nurses and reporting payroll data, 1,387 of the 15,616 skilled nursing facilities in the United States rated only one star out of a possible five.  In total, only 79 nursing homes in the U.S.  have a five-star rating.

Overall, the records obtained revealed that nursing home staffing levels were lower than what the nursing homes had disclosed themselves.  The greatest discrepancy was among the number of registered nurses on staff.  According to reports, Medicare lowered the star ratings after they discovered that the affected nursing homes reportedly:

  • Did not provide payroll data showing that they had required nursing coverage
  • Did not have an adequate staff of registered nurses
  • Had a “high number of days” with no registered nurse on duty

A Kaiser Health News analysis revealed that the downgraded star rating was fairly proportionate among nursing homes operated for-profit, nonprofits, and government-owned facilities.  For-profit facilities had an overall lower average of nursing staff than the other two categories.  The ratio of registered nurses to residents included:

  • One registered nurse for every 28 residents at nonprofit facilities
  • One registered nurse for every 43 residents at for-profit facilities

Since for-profit facilities comprise 70 percent of nursing homes in the U.S., the issue of staffing is certainly one to continue keeping an eye on.  Other areas to monitor include staffing fluctuations, and consistently lower staffing averages on weekends and holidays.

Nursing Homes Struggle to Comply with Guidelines

Registered nurses are a required part of nursing home staff.  They are highly-trained caregivers and can supervise other nurses and nursing aides.  According to Medicare guidelines, registered nurses must be on-hand in every facility for at least eight hours a day.  Many facilities have struggled to comply with this requirement.

For many years, Medicare received payroll and staffing information from the nursing homes themselves.  Only more recently did Medicare start receiving and publishing reports based on provisions of the Affordable Care Act of 2010.  The new staffing and payroll requirements have been difficult for some facilities who are reportedly struggling to meet reporting requirements.  Officials in the nursing home industry have stated that reporting deficiencies are largely due to a shortage in workforce – a staffing issue of its own.

Advocates for healthcare policies that protect nursing home residents argue that there is a positive change with so many nursing homes abiding by the new reporting guidelines, but more work is needed.  Medicare began warning nursing homes about the new payroll and staffing reporting requirements in 2015, and made it clear that there were consequences for failing to abide by the new guidelines.

Now, the Centers for Medicare & Medicaid Services (CMS) is hoping that reports like this one, and tightening down on reporting guidelines, will add more transparency and enforcement with the overall goal of improving patient safety and healthcare outcomes.

Staffing Concerns and Your Legal Rights

If you or someone you love lives in a nursing home, staffing concerns may be a very relevant issue.  You may have had a negative experience due to a staffing shortage or lack of a registered nurse on duty, or you may be afraid of what could happen if such a shortage occurs in your facility.

Whether you are a resident, family member, or outside caregiver, there are some warning signs you can look out for that may signal a staffing shortage.  These warning signs include:

  • Changes in the resident’s condition – health, mental, or hygiene
  • Unclean or unsanitary conditions in public or private areas
  • Lack of scheduled social events or outings
  • Lack of regular medical care on-site
  • Residents visibly wandering around, asking questions, or looking for staff
  • Staff is rude, annoyed, or appears fatigued
  • Inability to speak with a supervisor when visiting

It is incredibly important that nursing homes properly staff their facilities, especially nurses.  Nurses play a vital role in keeping residents healthy and safe.  In one survey, 46 percent of nurses admit that they have missed changes in a resident’s condition due to being overworked.

When nursing homes lack adequate staff, or the staff they have is overworked, there is a greater chance of abuse or neglect occurring.  In some cases, it may even be unintentional.  In all cases, it is unacceptable.

Get Advice from a Nursing Home Abuse Lawyer

To learn more about nursing home safety, abuse or neglect, or your legal rights, contact Nursing Home Abuse Center.  You can find a great deal of information on our website, or by viewing the topics available on our blog.  To schedule a free consultation with one of our attorneys, fill out our online form, or call toll free at 1-866-548-9636.


meagan cline

Written By Meagan Cline

Meagan Cline is a professional legal researcher and writer. She lends her expertise to FNHA and our websites, including Birth Injury Guide and