five star quality rating on a tabletIn December 2008, the Centers for Medicare & Medicaid Services (CMS) enhanced its Nursing Home Compare program by creating the Five Star Quality Rating System. This way, they figured, they could give residents and their families a quantifiable way to compare and contrast different care centers and quickly understand how well each one performs. With 2014’s IMPACT Act, this system received a major overhaul via a re-calibration of the quality standards used to measure nursing homes nationwide.

Fast-forward to February 20, 2015. On “Discovery Friday,” government officials released the new rating standards to the public, causing nearly one-third of the country’s skilled nursing facilities to lose a rating star overnight — without any change in quality. Was yours among them?

Luckily, there are things you can do. It’s time to learn how to catch a falling star:

Selecting The Right People

CMS maintains that there is a clear association between staffing ratios and quality of care, and we agree. Maintaining appropriate staffing levels to meet the needs of your residents is key. Each facility is scored based on the number of nursing staff hours per resident per day; the more attention your residents get, the better your five star quality rating will be.

It’s not enough to simply fill your staff, however. You have to find the right people if you want the best results. Adding members to your team won’t amount to much if they walk out the door a short time later. You have to find the caregivers who are passionate about their jobs — the ones who will stay. Use pre-interview assessments to better decide which applicants to interview, and implement job skill tests to see how your candidates will actually perform on the floor.

Retaining Your Caregivers

And what about the staff you already have? With CMS’s new standards, a high turnover rate is something your facility simply cannot afford. In order to raise your retention rate, just remember that the key to keeping good people is to keep them engaged. Start a mentoring program for your new hires; pair up your senior staff members with your new caregivers. That way, your seasoned caregivers get to share their experience and knowledge, while your new hires learn from people who already know the ropes of your facility.

While employee engagement can mean something a little different to everyone, the core of it remains the same: it’s about relationships. The better relationship you have with your staff, the more likely they are to stick around. Be sure to recognize employees who go above and beyond, setting a good example for your other staff members. Give honest, yet tactful, feedback to your employees to show them that you have both their best interests and those of your residents in mind. Above all, be available… and not just by phone or email. Make sure your employees know that you are in their corner. Be their supervisor, but also be their advocate.

The RN Component of the Five Star Quality Rating

The number of RN hours per resident per day is a separate staffing measure that affects your facility’s star rating. If you find yourself short on RNs, consider investing in your LPNs with a tuition reimbursement program. It is far less expensive to invest in an existing staff member than it is to hire a new one, and your encouragement to further her education and career is likely to keep her around even longer.


The Five Star Quality Rating System has changed, and it’s getting harder to keep those stars. But harder doesn’t mean impossible. Just focus on the relationship between you and your staff, and you won’t have to worry about falling stars.

For all the details you could possibly want about the newest Five-Star Quality Rating System, visit cms.gov and check out the downloadable PDFs at the bottom of the page.

Ryan Haddock

About Ryan Haddock

Ryan Haddock is a Marketing Manager for HealthcareSource, focusing on the company's senior living and staffing solutions. As a marketing manager, Ryan helps connect providers with a software platform that will help them hire, keep, and grow the right people. When he isn't scrawling plans onto white boards or tapping away at a laptop, Ryan enjoys reading, writing short stories, and spending time with his wife and three boys.