Using the records

How to read nursing home staffing numbers

Staffing figures can help you ask better questions about a nursing home. They describe a reporting period, not the number of people working on the day you visit.

Start with the date and the measure

CareLedger displays the staffing figures published in the CMS Provider Information dataset. Check the processing and retrieval dates on the facility page before comparing homes. Reported nurse hours per resident per day is a ratio across a reporting period; it is not the time that any one resident received from a nurse. If a value or footnote is missing, do not read the blank as zero.

Read the hours and rating together

Look at reported registered nurse (RN) hours, total nurse staffing hours, weekend hours where available, and the CMS staffing rating. These are different measures. Medicare explains that its staffing rating considers RN and total staffing hours, weekend staffing, nurse turnover, administrator departures, and differences in residents’ care needs. A star rating does not tell you how a particular shift went.

Know what an average cannot show

An average does not show who was on duty on a particular night, how staff were assigned, or what happened when someone called in sick. CMS data can lag and can later be corrected. CareLedger does not yet show a dated, day-by-day Payroll-Based Journal staffing history. The numbers are useful context, not a live staffing count or a verdict on safety or care.

Questions to take on a visit

• How many RNs, licensed nurses, and aides are usually assigned to this unit on days, nights, and weekends?
• How do you cover absences and changes in residents’ needs?
• What period do the published staffing figures describe, and what has changed since then?

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Sources: CMS Provider Information and Medicare staffing guidance. Verify current staffing directly with the facility.