By Paulette Wunsch, September 10, 2026
Staffing, Staffing, Staffing!
CMS and state departments of health use staffing metrics as an important measure of skilled nursing facility—or nursing home—quality. Staffing is certainly a metric that is relatively easy to determine, measure, and benchmark. But numbers do not always tell the whole story. A skilled nursing facility may have excellent outcomes, strong leadership, and dedicated staff that are not fully captured by a staffing metric.
Staffing has been a challenge since the pandemic, and some regions have found it particularly difficult to recruit and retain qualified workers.
Immigration Changes Add to the Staffing Challenge
Post-pandemic, nursing homes now must also contend with the potential loss of legally authorized immigrant workers who make up a substantial segment of the long-term-care workforce.
Recent changes in federal immigration policy, particularly involving Temporary Protected Status (TPS), have significant implications for Haitian healthcare workers. Haitian immigrants have an important presence in the long-term-care workforce. Reuters recently reported that approximately 21,000 Haitian TPS holders working as caregivers and nursing assistants served an estimated 77,000 patients nationwide.
Reuters: U.S. families, healthcare providers under strain after crackdown on Haitian TPS holders
More broadly, immigrants make up a substantial segment of the long-term-care workforce, both in nursing facilities and in patients’ homes. According to KFF, immigrants account for approximately 30% of direct-care workers in long-term-care settings.
KFF: The Role of Immigrants in the U.S. Health Care Workforce
The loss of TPS can result in affected workers losing authorization to work legally in the United States, potentially removing experienced caregivers from an already strained workforce.
For skilled nursing facilities, the issue is especially consequential. At the same time facilities are struggling to recruit and retain staff, staffing performance is becoming increasingly important to how CMS evaluates and publicly identifies high-performing nursing homes.
CMS’s New High-Performing Nursing Home Program
CMS has begun a program under which qualifying high-performing nursing homes will be surveyed less frequently. Staffing is one of the criteria used to determine whether a facility qualifies. It will implement the new program as of September 8, 2026. https://www.cms.gov/newsroom/press-releases/cms-modernizes-nursing-home-oversight-new-risk-based-survey-approach-designed-highlight-high
As CMS explains:
“For example, because the staffing star rating is one of the qualification criteria — and adequate staffing is closely linked to many aspects of quality — the program creates an incentive for facilities to strengthen their staffing levels. “
CMS believes that the program will encourage facilities to strengthen staffing levels because the staffing star rating on the CMS Care Compare website is one of the qualification criteria for the icon.
This means staffing matters—not only operationally, but also to how a nursing home is evaluated and presented to the public.
When families look for a nursing home, many use Medicare’s online Care Compare tool to evaluate facilities. Qualifying high-performing nursing homes will now receive a special icon on Care Compare.
Medicare Care Compare: Nursing Homes
CMS announced implementation of the new nationwide risk-based survey process for high-performing nursing homes beginning September 8, 2026.
Approximately 12% of nursing homes are expected to qualify initially, based on rigorous criteria that include five-star performance, accurate data submissions, no harm-related citations during the applicable survey cycle, and no recent ownership changes. Qualifying facilities will be identified with a special icon on Medicare’s Care Compare website.
But Is a Star Rating the Whole Story?
The new program creates an incentive for nursing homes to improve staffing and other quality measures. But it also raises an important question: Will families increasingly choose nursing homes based on the CMS designation without considering other factors that may be equally important?
Choosing a nursing home for a parent or loved one is a nuanced decision. Quality and staffing are critical, but so are proximity to family and friends, familiarity with the community, leadership, continuity of caregivers, culture, specialized services, and the individual needs of the resident.
A highly rated facility located farther away may not always be the best choice if the distance makes regular visits from family and friends difficult. Residents can lose important connections with the people and communities that have been part of their lives.
There may also be consequences for nursing homes themselves. Facilities serving communities already experiencing workforce shortages could face additional difficulty competing for admissions if families increasingly gravitate toward facilities displaying the CMS high-performance icon. For some facilities, declining admissions could make remaining financially viable even more difficult.
The Challenge Ahead
Skilled nursing facilities are therefore facing pressures from several directions at once: persistent workforce shortages, potential losses of experienced immigrant healthcare workers, increasing emphasis on staffing measures, and greater public visibility of CMS quality ratings.
Staffing matters. Quality matters. But choosing and evaluating a nursing home should involve more than a single metric, star rating, or icon.
The challenge for policymakers, nursing homes, residents, and families will be ensuring that efforts to recognize high-performing facilities improve quality without overlooking the realities facing individual facilities—or the communities and residents they serve.