3 Tips For Five-Star Staffing Success

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Spotlight On Staffing

3 Tips For Five-Star Staffing Success A major transformation of the Five-Star Quality Rating system is about to happen. Are you ready? The Centers for Medicare & Medicaid Services (CMS) announced major changes to the Five-Star Quality Rating system – putting a spotlight directly on the staffing practices of long-term and post-acute care providers. Currently 55% of nursing homes have a 4 or 5 star staffing rating, but recent reports claiming that nursing homes are inflating staffing level numbers to improve their Five-Star Quality Rating have called these ratings into question. In fact, according to the Center for Public Integrity, 80% of skilled nursing facilities might have inflated registered nurse staffing levels. This has led to sweeping changes to the Five-Star Quality Rating system which will now focus on improving the accuracy and transparency of these staffing numbers. “For the first time in my more than 40 years in the field of aging services, the President is recognizing the importance of ensuring nursing homes are providing the highest quality of care in an efficient and transparent manner.”

Larry Minnix President, LeadingAge 1621 Euclid Avenue • Cleveland, OH 44115 • (216) 333-1353 • www.OnShift.com • [email protected]

The viability of your organization may be on the line, with so much riding on your Five-Star Quality Rating. Potential residents and their families, hospitals, healthcare providers and other referral sources rely on Five-Star Quality Ratings day in and day out to evaluate and compare facilities against one another. Get ahead of the pack by exploring these changes, find out what they mean to your staffing strategy, and put a plan in place to be successful by optimizing your staffing efforts.

Five-Star Rating: What Do The Changes Mean? Beginning January 2015, CMS will take the following steps to validate and improve the reliability of staffing data reported on Nursing Home Compare by:  Implementing Payroll-Based Staffing Reporting Nursing homes will be required to submit quarterly electronic reports of their staffing levels. This information will be verified by payroll data and also allow for the calculation of other quality measures including staff turnover and retention. CMS will begin pilot testing this system in 2015 and expects all nursing homes to be using the system by the end of 2016.  Conducting Focused Staffing/Minimum Data Set (MDS) Surveys Nationwide surveys will be conducted to verify MDS coding accuracy and nursing home staffing levels. Record review, resident observations, and staff/resident interviews will be used during this 2-day process for data validation.  Changing Five-Star Scoring CMS is also changing the way in which they calculate Five-Star Quality ratings, placing more emphasis on data that is verified by independent sources rather than data that is self-reported. In addition to staffing, CMS will introduce additional quality measures and strengthen requirements to ensure that states complete inspections of nursing homes in a timely and accurate manner.

3 Tips For Five-Star Staffing Success Take control of your Five-Star Staffing Rating by implementing processes to hit your staffing targets and ensure you consistently have the right staff in the right place at the right time to deliver the high quality care your patients and residents deserve. “The inclusion of verified staffing information based on payroll data is especially important, as staffing levels are often the best proxy for quality.”

Cheryl Phillips, M.D. Senior Vice President of Public Policy and Advocacy, LeadingAge

1621 Euclid Avenue • Cleveland, OH 44115 • (216) 333-1353 • www.OnShift.com • [email protected]


Get Predictive & Flexible With Five-Star Quality ratings, organizational performance, and quality care on the line, the best staffing strategy is one that prioritizes flexibility and predictability. Administrators or schedulers should evaluate staffing plans on a rolling 7-day basis to make sure needs are covered and adjustments to staffing levels can be made. Flex staffing based on known census changes or use an estimated future census. For example, if several resident admissions are planned for the next day, calculate the additional hours needed to hit your staffing target. Additionally, if several discharges are

“Nursing home quality hinges upon high staffing levels. If we are able to get better information on staffing levels, the higher the quality is going to be in the long run.”

planned, there may be an opportunity to flex staffing down to optimize efficiencies while still providing quality resident care.

Brian Lee Executive Director Families for Better Care

If a potential understaffing situation arises, due to a last minute employee call-off or influx of unplanned admissions, you should have an emergency plan in place to staff up quickly. This plan should identify which employees are qualified and available to fill the opening so you can communicate with them as soon as possible. Also consider float employees who may be able to fill the opening or a PRN pool of potential candidates. In addition, determine if it’s possible to re-assign credentialed supervisory employees who are already on-hand to assume the open shift. If you do this, be sure to add the supervisor to the schedule in that role, to verify and document that the shift was filled appropriately.


Staff To Acuity, Census & Activity Resident acuity is on the rise, as individuals have increasingly complex medical conditions and extensive needs for care and support. According to the 2013 AHCA Quality Report, in an analysis done on five activities of daily living including bathing, bed mobility, transfer, toilet use and eating – 95.2% of individuals who enter a center for a Medicare-covered, post-acute stay require assistance with four or five of these activities. With complexity of care considered in the Five-Star Quality Rating, how you staff to resident acuity can make a significant difference to your rating. Make adjustments not only based on census, but also on resident acuity. Administrators and Directors of Nursing should consider grouping care needs based on complexity and required nursing time. When resident acuity escalates, consider redeploying staff or adding more employees to ensure resident needs are met. When resident acuity levels dip, this might allow you to reduce staff while still providing high quality.

1621 Euclid Avenue • Cleveland, OH 44115 • (216) 333-1353 • www.OnShift.com • [email protected]

In addition, it’s important to pay close attention the activities of your staff members. Family meetings or unexpected admissions can consume more time than anticipated, taking caregivers away from providing direct resident care. To minimize impact, create a policy that manages these “activities” like an employee absence. For example, when caregivers are pulled away, rely on your emergency plan to help fill those shifts.


Make Staffing A Daily Process Remember the way you staff each and every shift will be critical to your Five-Star Staffing success. Managing staffing based on historical data won’t cut it in this new age of transparency. Staffing is a dynamic process with constant shift updates including call-offs, time-off requests, employee no-shows, and fluctuations in census. Writing and publishing static schedules weeks or even days ahead of time can leave teams unprepared to manage unanticipated changes and open shifts. Ensure that your communities are properly staffed to deliver high quality resident care by having administrators or schedulers examine staffing levels every day. For a short-stay population, consider creating a policy to ensure that staffing levels are checked and potentially modified more frequently, each and every shift. Set up a process that allows staffing information to be easily accessed. Dashboards that identify staffing requirements based on census, against scheduled hours, will help identify any gaps so adjustments can be made. Creating a strategic staffing plan and updating it daily is the first important step to effectively preventing staffing shortages and keeping your organization on track to staff properly each and every shift to achieve your Five-Star Staffing success.

OnShift For Five-Star Staffing Success OnShift staff scheduling and labor management software can help you overcome workforce challenges and improve operational, financial and clinical outcomes through proper and consistent staffing. OnShift focuses exclusively on long-term care and senior living. OnShift partners with providers on their labor management strategies, delivering best practices and automating key scheduling and staffing processes to ensure that employees are at the right place, at the right time to deliver quality care and services to patients and residents.  Staff to resident and patient census and acuity  Get visibility into staffing across properties  Notify management with proactive alerts before shortages occur  Predict gaps in the schedule through automated calculation of required hours  Communicate openings to all available and qualified staff via text message, email, automated phone call or mobile push notification

1621 Euclid Avenue • Cleveland, OH 44115 • (216) 333-1353 • www.OnShift.com • [email protected]