Five-Star Ratings Updated and Second Quarter PBJ Staffing Data Released

Research and Data; Workforce; PBJ

While Survey Ratings Remain Frozen, Staffing Ratings are Updated

On Wednesday, October 28 Nursing Home Compare and Five-Star ratings were updated. Survey Ratings did not change as traditional nursing home surveys have not yet resumed equally across the nation and CMS prioritizes focus surveys on infection prevention and control during the COVID-19 pandemic. 

Quality Ratings were updated to reflect the replacement of the short-stay pressure ulcer measure with a new Quality Reporting Program (QRP) measure—Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury. All quality measure data still only reflects data up to the fourth quarter (Q4) of 2019 and before the COVID-19 pandemic. There were minimal changes in Quality Ratings.

Staffing Ratings were updated and reflect Payroll Based Journal (PBJ) data for Q2 2020 (April – June 2020). Previously, Staffing Ratings were based on Q4 2019 PBJ data because Q1 2020 data submission was optional due to COVID-19.

While these government ratings are helpful in understanding overall quality of care, independent research indicates that Five-Star Ratings, prior citations or staffing are not determining factors when it comes to COVID outbreaks in nursing homes. The location of a nursing home and its surrounding community’s prevalence of COVID among the general population are the strongest indicators. 

Overall Five-Star Ratings Remain Similar

In a preliminary analysis of Overall Five-Star ratings before and after October’s update, most nursing homes did not see a change in their Overall
Rating. Specifically, 1,838 (12%) nursing homes had their Overall Rating increase by one or more stars. While another 956 (6%) nursing homes had their rating decrease. Leaving over 80% of nursing homes with no change in Overall Rating.

Here is the distribution of Five-Star Overall Ratings before and after October’s update:


Staffing Five-Star Ratings and Hours Per Resident Day Increase

Nationally, the direct care staff (Nurse Aides, LPN/LVN, and RN) hours per resident day (HPRD) went from an average of 3.87 in Q4 2019 to 4.06 in Q2 2020. As a result, a quarter of nursing homes saw an increase in their Staffing Five-Star Rating.

Payroll-Based Journal (PBJ) National Averages
Q4 2019 (n=14,859)Q2 2020 (n=14,677)
Adjusted RN Hours per Resident Day0.700.78
Total Direct Care Staff Hours per Resident Day3.874.06

Note: Q1 2020 PBJ staffing data submission was optional and not included in Five-Star. Source: CMS Nursing Home Compare

Here is the distribution of Five-Star Staffing Ratings before and after October’s update:


View Your Latest Five-Star Ratings and Staffing Data in LTC Trend Tracker

This federal data has been added to LTC Trend Tracker. AHCA/NCAL members can view their facility(ies) or company’s latest star ratings and staffing HPRD relative to other nursing homes in their city, county, state, or nation. The data is available in LTC Trend Tracker’s Five-Star Overall and Five-Star Staffing Reports. Login now: