PBJ Insights into Five-Star Success: Your Path to Excellence in Nursing Home Staffing

PBJ Insights into Five-Star Success: Your Path to Excellence in Nursing Home Staffing

Achieving a five-star staffing rating is a critical measure of success for nursing homes. This rating not only reflects the quality of care provided but also impacts the facility’s reputation, marketability, and financial performance. In this blog, we’ll break down the key components of the staffing rating and offer actionable strategies to help your facility achieve five-star success.

Understanding the Five-Star Staffing Rating

The Centers for Medicare and Medicaid Services (CMS) calculates the staffing rating using data submitted quarterly through the Payroll-Based Journal (PBJ) system. Several staffing metrics are analyzed to determine a facility’s score, which directly impacts the overall five-star rating. The primary components include:

1. Adjusted Total Nursing Hours per Resident Day (HRD)

• Accounts for hours worked by Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and Certified Nursing Assistants (CNAs), adjusted for the acuity of the facility’s residents.

2. Adjusted RN Nursing Hours per Resident Day

• Focuses on hours worked specifically by RNs, including Directors of Nursing and RNs with administrative duties, to ensure adequate clinical oversight.

3. Adjusted Total Nursing Hours on Weekends

• Evaluates staffing levels on weekends to ensure consistent care across all days.

4. Total Nursing Turnover

• Measures the percentage of nursing staff who left the facility over a 12-month period.

5. RN Turnover

• High RN turnover rates can signal instability in clinical leadership , affecting care quality.

6. Administrator Turnover

• Assesses changes in facility leadership, as frequent transitions can disrupt operations and morale.

How the Staff Turnover Measure is Calculated

CMS revised the nursing home staffing turnover methodology on July 31, 2024, to exclude employees on leave for 90 days or less from being counted as turnover. The turnover measures now include:

• The percentage of nurse staff who stop working at a facility.
• The number of administrators who leave the facility within a given year.

This adjustment, increasing the leave exclusion from 60 to 90 days, aligns with the Family and Medical Leave Act (FMLA) to account for 12 weeks of maternity or parental leave. This change is expected to lower reported turnover rates.

Strategies for Achieving Five-Star Staffing Success

Improving your staffing rating involves strategic planning, accurate reporting, and fostering a supportive work environment. Here are actionable strategies to excel in the PBJ-driven metrics:

1. Submit Accurate and Timely PBJ Data

• Ensure all PBJ submissions are precise and timely; inaccuracies or missed deadlines can lead to deductions.
• Regularly review and validate staffing data to avoid discrepancies.

2. Maintain Adequate Staffing Levels

• Use CMS benchmarks to determine appropriate staffing levels for RNs, LPNs, and CNAs.

Monitor weekend staffing closely, as it significantly affects your score.

3. Reduce Staff Turnover

• Retention Strategies: Implement mentorship programs and promote a positive workplace culture to minimize burnout.
• Career Growth Opportunities: Offer continuing education, leadership pathways, and competitive benefits to retain skilled staff.
• Recognition Programs: Celebrate staff achievements regularly to build morale.

4. Ensure Leadership Stability

• Minimize turnover in key leadership roles like administrators and Directors of Nursing. Develop leadership succession plans to ensure smooth transitions.

5. Leverage Data for Continuous Improvement

• Use CMS CASPER Reports to verify submitted data and identify staffing trends or gaps.
• Analyze PBJ data to address areas needing improvement, such as high turnover or weekend staffing shortages.

6. Invest in Recruitment and Retention

• Offer competitive salaries and benefits packages.
• Partner with local nursing schools to create a pipeline of skilled professionals.
• Conduct regular staff engagement surveys to address concerns and improve satisfaction.

Common Pitfalls and How to Avoid Them

While striving for a five-star staffing rating be mindful of these common challenges:

• Over-reliance on Agency Staff: High usage can indicate instability. Build a strong internal team to reduce dependence.
• Understaffing on Weekends: Weekend staffing shortages can lower your rating. Plan ahead to ensure consistent coverage.
• Neglecting Turnover Rates: High turnover disrupts care and reduces ratings. Focus on creating a stable workplace.

Why Five-Star Staffing Matters

A five-star staffing rating doesn’t just improve your CMS five-star rating score; it enhances resident outcomes, boosts staff satisfaction, and strengthens your facility’s reputation. High staffing ratings signify reliability and quality, attracting more residents and improving financial performance.

Final Thoughts

Achieving and maintaining a five-star staffing rating requires commitment, strategic planning, and attention to detail. By focusing on accurate reporting, reducing turnover, and fostering stable leadership, your facility can excel in CMS’s staffing metrics. Leverage data, technology, and a supportive workplace culture to drive continuous improvement. Ready to take your staffing metrics to the next level? Start implementing these strategies today to achieve five-star success! https://www.cms.gov/medicare/quality/nursing-home-improvement/staffing-data-submission

Contact Proactive to learn more about Five-Star Improvement support services and develop a road map to Five-Star success in 2025.