Facilities that swing widely between well-staffed and thin-staffed days may look good on average, but would become more exposed under this proposed measure.
Median-based variation measures, particularly median-CDMAD, exhibit the greatest validity relative to nursing home quality outcomes, making them suitable for CMS’s staffing star rating system. Incorporating daily staffing level variation can improve public information on staffing consistency and incentivize quality improvement in nursing homes.
— Journal of the American Medical Directors Association, May 2025
Brunt, Christopher S., and John R. Bowblis. “Nursing Home Staffing Variability and Quality: Assessing Alternative Measures of Daily Staffing Level Variation” Journal of the American Medical Directors Association, vol. 26, no. 5, 2025, jamda.com/article/S1525-8610(25)00049-0/abstract.
Study proposes new measure for CMS to consider in nursing home quality ratings
The findings showed that the median of daily staffing variations recorded accurately predicted 89% of quality outcomes. Each of the five other measures predicted 78% of quality outcomes.
Fluctuation in staffing levels is common, Bowblis confirmed. If CMS were to consider this factor when determining quality, many facilities could possibly avoid lower ratings due to the operational ebbs and flows of skilled nursing.
— McKnight’s Long-Term Care News, March 4, 2025
