Also, staffing around the time of the annual survey could exceed typical staffing levels if facilities increase staffing during their anticipated survey window.
Because CASPER data are facility-reported over a two-week look-back period, they are susceptible to upcoding by facilities and have not been subject to audit. First, PBJ and CASPER staffing data are measured with potential error. For additional details on our data and methods, see the online appendix. 7 This information is updated monthly, and we used the information available as of March 2018 to categorize facilities based on their organizational characteristics.įor each analysis, we excluded facilities with missing information and reported the resulting sample size.
#STAFFING DATA CMS NURSING HOME COMPARE VERIFICATION#
CMS calculates expected staffing levels for each facility, adjusting for the acuity of residents in the facility and based on the Staff Time and Resource Intensity Verification Study. 6įrom Nursing Home Compare, we collected additional facility information, including ownership type, size, overall five-star rating, and expected staffing levels. For PBJ and CASPER data, we applied inclusion and exclusion criteria consistent with those used in the CMS Five-Star Quality Rating System. For comparison, we obtained facility-reported staffing and resident census data and annual inspection survey dates from the Certification and Survey Provider Enhanced Reports (CASPER) for calendar years 20. We used data on daily resident census and payroll-based measures of nurse staffing to calculate hours per resident day by staff category.
We obtained facility-level data from the Long-term Care Facility Staffing Payroll-Based Journal for the one-year period of April 2017–March 2018. In this article we showcase the more granular PBJ staffing data as a new and valuable resource to expand the evidence base on nursing home staffing by analyzing PBJ and facility-reported staffing levels, staffing at the time of the annual inspection relative to the rest of the year, staffing across different days of the week, facility factors associated with low weekend staffing, observed versus expected staffing based on resident acuity, and compliance with federal nurse staffing standards.
Reflecting the potential value of the PBJ data, CMS began using them as the source for staffing information in Nursing Home Compare and the Five-Star Quality Rating System in April 2018. We then compared the reported staffing level on each day to the threshold for that month and calculated what proportion of the time during a year facilities met or exceeded the expected level of staffing. For each facility, we used the monthly expected staffing level as a threshold for the entire month. “NA” includes the categories of certified nurse aide (CNA), nurse aide in training, and medication aide or technician. “LPN” includes the categories of licensed practical nurse and LPN with administrative duties. “RN” includes the categories of registered nurse, RN director of nursing, and RN with administrative duties. From Nursing Home Compare, we obtained expected staffing levels for each nursing home, which are calculated by CMS after adjusting for the acuity of residents in each facility, based on the Staff Time and Resource Intensity Verification Project Study (see note 7 in text). SOURCE Authors’ analysis of data from the Long-term Care Facility Staffing Payroll-Based Journal (PBJ) and Nursing Home Compare. Importantly, the data suggest that a large proportion of nursing homes often have daily staffing below CMS’s case-mix-adjusted expected staffing levels ( exhibit 1).Įxhibit 1 Percent of nursing homes that met the staffing levels expected by the Centers for Medicare and Medicaid Services (CMS) for all staff categories and total staffing time, by percent of days when expected levels were met, April 2017–March 2018 5 With their detailed daily snapshots, PBJ data permit deeper insights into staffing patterns than was previously possible. 1 – 4 In 2016 the Centers for Medicare and Medicaid Services (CMS) introduced the Long-term Care Facility Staffing Payroll-Based Journal (PBJ) system, to which nursing homes are required by Section 6106 of the Affordable Care Act to submit auditable payroll-based staffing and resident census data quarterly. 1 Researchers have questioned the completeness and accuracy of these rarely audited facility-reported staffing data. Since staffing data were first reported on the website in 1998, Nursing Home Compare has relied on facility-reported data that describe staffing during the two weeks before each nursing home’s annual recertification survey. Staffing is an important quality measure used to profile nursing homes on the federal Nursing Home Compare website.
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