Nursing Homes Lost Half Their Staff During Pandemic, and Many Haven’t Replaced Them: CMS Warns

Nursing home staffing losses played a key role in widespread COVID-19 deaths at long-term care facilities.

As nursing homes across the U.S. continue to struggle with staffing shortages following the devastating impact of COVID-19, the Centers for Medicare & Medicaid Services (CMS) has launched a new transparent web service that will publicly display turnover and staffing level shortages at nursing home facilities.

The CMS launched its enhanced Nursing Home Five-Star Quality Rating System late last month, which displays weekend staffing rates and information on annual turnover among nurses and administrators.

CMS indicates more than 240,000 nursing home employees were lost since the start of the pandemic. However, many of those still have not been replaced, which places residence at an increased risk of nursing home neglect and preventable injuries.

Nursing homes were significantly affected by the pandemic. More than 200,000 residents and staff in nursing homes died from COVID-19, partially linked to problems stemming from understaffing. However, since the pandemic has continued, nursing homes have struggled to recover and face a lack of staff and inability to care for residents.

The nursing home rating website changes come amid continued efforts to make selecting a nursing home for seniors and loved ones more transparent, as CMS research has found nursing homes with poor staffing levels or high turnover rates are associated with lower quality of care.

The new data being displayed on the Nursing Home Five-Star Quality Rating System focuses on the staff directly interacting with patients on a day-to-day basis and includes licenses practical nurses, vocational aids and nurse aids. CMS states these positions are often responsible for a client’s daily wellbeing; providing medication and other critical needs to patients such as eating, bathing, grooming and toileting.

“Research and experience tell us that staffing levels and staff turnover can substantially affect quality of care and health outcomes for people living in nursing homes,” CMS Administrator Chiquita Brooks-LaSure said in the press release. “This enhancement to the Five-Star Quality Rating System helps to better inform consumers and residents about the care each nursing home provides and encourages nursing homes to improve the staffing of their facilities to foster better outcomes for residents.”

According to the release, CMS is making this data public to publicly hold Medicare and Medicaid facilities accountable and incentivize them to strengthen their focus on staffing and providing better quality of care for residents.

CMS states the ratings applied to nursing home staffing information will be updated quarterly and can be found on their website, where prospective residents and workers can search for all Medicare and Medicaid facilities rating.

Nursing Home Staffing Shortages

The launch of the enhanced Nursing Home Five-Star Quality Rating System follows a recent study published in the Journal of American Medical Association (JAMA) which found nursing home staffing levels in some areas dropped more than 50%, and despite efforts of hiring and increased pay, have still not fully replaced lost staff, particularly certified nursing assistants.

The study found a direct link between severe COVID-19 outbreaks and significant drop in nursing staffing levels at nursing home facilities, calling for a much needed policy action to ensure mandatory staffing levels during and after an outbreak.

In June, the American Health Care Association’s (AHCA) conducted a survey of 759 nursing home providers, finding more than 73% of U.S. nursing homes report that they at risk closing due to staffing shortages stemming from the COVID-19 pandemic.

The survey also found roughly 60% of nursing homes said their staffing situations worsened since the start of 2022 and nearly 90% of nursing homes are facing moderate or high staffing shortages. At least 98% of participating nursing homes also report they are experiencing difficulty hiring staff and 99% said they are asking current staff to work overtime.