Medicare rates nursing homes on a five-star system – under the changes, 1,387 out of 15,616 nursing homes received a rating of just one star.

One in 11 US nursing homes have had their star ratings for staffing levels cut because they either had inadequate numbers of registered nurses or failed to provide payroll data that showed they had the required nursing staffing after new federal records were published.

Medicare recently began collecting and publishing payroll data under the Affordable Care Act introduced by former President Barack Obama in 2010 rather than relying on the homes’ own unverified reports.

The records prove staffing was lower than homes had reported, particularly among registered nurses, with the average home having one registered nurse caring for between 17 and 33 residents depending on the day. Weekends were the worst-off, with 11% fewer nurses and 8% fewer aides.

But while staffing was 16% lower for-profit facilities than Not For Profits and government-owned homes, the number of downgraded homes was roughly equal between the three – suggesting an industry-wide problem.

Katie Smith Sloan, President of LeadingAge, which represents Not For Profits with around 2,000 homes, has blamed workforce shortages for the figures.

“Our members are battling on multiple fronts to recruit and retain all types of qualified staff, and nurses in particular,” she said in a statement.