Since the COVID-19 pandemic began, the nursing home industry has struggled with a labor shortage unlike anything seen since 1994. There has been more than a 13% decline in the nursing home workforce, and 84% of nursing homes currently face moderate to high staffing shortages.1 In other words, things have been tough for skilled nursing facilities. For nursing homes, a side effect of the labor shortage is an impact on Five-Star Quality Ratings. Staffing shortages majorly impact these ratings and can cause a domino effect, leading to lower census and fewer referrals.

The Centers for Medicare and Medicaid Services (CMS) created the Five-Star Quality Rating system to give consumers a way to navigate the complex world of post-acute care. Because these ratings are an important tool for consumers and referral sources, operators of skilled nursing facilities consistently work toward achieving the best rating possible. The Five-Star Quality Rating comprises three categories: staffing, health inspections, and quality measures. Given that 96% of nursing homes are experiencing difficulty hiring staff1, it’s no surprise that good star ratings are at stake.

Despite industry-wide staffing challenges, focusing on improving your staffing star rating is a great way to bring up your overall rating. The staffing portion of the rating is based on six measures:2

  • Case-mix adjusted total nurse* staffing levels**
  • Case-mix adjusted RN staffing levels
  • Case-mix adjusted total nurse staffing levels on the weekend
  • Total nurse turnover***
  • Registered Nurse (RN) turnover
  • Administrator turnover


Here are some things to consider when trying to improve your staffing star rating:

Continuously monitor staffing levels – Daily (or more frequent) monitoring of staffing levels is imperative, especially for short-stay populations. By having a strategy to track your staffing levels accurately, you can ensure that any staffing gaps are quickly identified and addressed.

Adjust staffing based on census, resident acuity and caregiver competency –Staffing shouldn’t be based on census alone. Consider the acuity of patients and residents to ensure enough attention is given to each individual. Additionally, caregiver competency is an important consideration when creating your schedule. Considering both competency and acuity when creating your schedules can help your facility provide the best possible care. CMS has a Nursing Home Staff Competency Assessment manual to help get you started.

Have a plan in place to fill shifts – Make sure someone on your staff stays up to date on ever-evolving guidelines and regulations. At any time, CMS can change how they calculate star ratings. Most recently, in July 2022, CMS changed the methodology for calculating the staffing star rating and the overall star rating.2 It’s estimated that 10 to 16% of providers could see their overall rating dip due to this new scoring methodology.3 Previously, nursing homes would receive an extra star on their overall rating if they achieved a 4-star staffing rating or above. Now, CMS only gives an extra star on the overall rating if a facility achieves a 5-star staffing rating.

Report staffing accurately – Ensure that hours reported and hours verified match. If there are significant inaccuracies, or if you fail to submit data by the deadline, CMS will assume you have low staffing levels, which will result in a one-star staffing rating.4

Don’t let staffing become the reason your overall rating is lowered. On-demand, tech-based companies can help you find the clinicians you need to fill gaps in your schedule. Gale Healthcare Solutions is an industry leader in on-demand staffing. Gale has 60,000 clinicians across 40 states ready to step in and ensure your staffing levels are where they need to be. Contact us here for more information about how we can provide an efficient, affordable solution that supports a Five-Star Quality rating for your community.


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* “Total nurse” is defined as RN, LPN/LVN and aides
** “Staffing levels” is defined as hours per resident day
*** “Turnover” is defined as the percentage of staff that left the nursing home over a twelve-month period.