Five-Star Technical Users’ Guide Updated to Reflect Staffing Methodology

On January 14, 2022, an updated Design for Nursing Home Five-Star Quality Rating System: Technical Users’ Guide was released by the Centers for Medicare & Medicaid Services (CMS). The document includes revisions to two staffing-related changes that will be impacting nursing homes in 2022. First, effective with the January 2022 refresh of Care Compare, the following information will be posted on the publicly available website:

Weekend Staffing

  • Level of Registered Nurse (RN) staffing on weekends at each nursing home over a quarter
  • Level of total nurse (RN/LPN/CNA) staffing on weekends at each nursing home over a quarter

Using PBJ and MDS census data, CMS will calculate weekend staffing (Saturdays and Sundays) in the quarterly reporting period. This information will be posted on Care Compare later in January and then will be used as part of the Staffing Domain calculation beginning July 2022.

Staff Turnover

  • Total nurse turnover in a 12-month period
  • Percentage of nursing staff that stopped working at the nursing home over a 12-month period
  • Number of administrators who stopped working at a nursing home over a 12-month period

This information will be available on Care Compare in January and will be used as part of the Five-Star Quality Rating System calculation for the Staffing Domain in July 2022. Currently, the staffing measure for the Five-Star Rating uses Payroll-Based Journal (PBJ) data and MDS information to calculate ratings for:

  • RN hours per resident day
  • Total nurse hours per resident day (RN/LPN/CNA)

CMS will continue to use PBJ data to calculate the turnover measure. The types of staff that will be included in the turnover measures include RNs (RN DON, RNs with administrative duties and RNs), Total nurses (RN DON, RNs with administrative duties, RNs, LPNs with administrative duties, LPNs, CNAs, aides in training, and med techs/aides), and well as nursing home administrators.

The PBJ data does not include employee termination dates, so the measure will identify turnover based on gaps in days worked and employee systems IDs. The calculation for annual turnover requires six consecutive quarters of PBJ data. A baseline quarter (prior to the first quarter) will be used, along with the first two quarters of data to identify employees who are eligible to be included in this measure. It is interesting to note that employees who return to a facility after a gap of more than 60 days are “essentially” treated as new employees. The calculation is:

(Total number of employment spells that ended in turnover)/(Total number of eligible employment spells).


These changes were announced in a January 7, 2022 QSO Memo, “Nursing Home Staff Turnover and Weekend Staffing Levels.” The January 2022 Five-Star Technical Users’ Guide can be viewed here.


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