FAQ: How We Rate Nursing Homes

Health inspections, nurse staffing, and quality of medical care determine each home’s star ratings


Senior father with his daughter.

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As loved ones age and lose their ability to function on their own, maybe for just a few days or weeks after a hospitalization but perhaps much longer, their families may need to consider a nursing home.  To help narrow their search, U.S. News has compiled information for nearly 16,000 facilities across the country. This FAQ explains what goes into the evaluations and addresses questions of interest to media and health care professionals.

Where can I find the ratings?
Best Nursing Homes allows you to search for a home by ZIP code.
Nursing Homes by Location allows you to select a state, region or metro area for your search.
Nursing Homes Search allows you to search for a nursing home by name.

[See America’s Best Nursing Homes and search for one near you.] 

Why does U.S. News rate nursing homes? 
On any given morning this year, roughly 1.4 million individuals, including one in every 34 individuals 65 and older, will wake up in a U.S. nursing home. We want to help families find a good and caring facility for those they cherish.

How is Best Nursing Homes organized?
Each nursing home receives an overall rating of one to five stars, based on its number of stars in three categories: state-conducted health inspections, how much time nurses spend with residents and the quality of medical care. Facilities in all 50 states and Washington, D.C., are included. Best Nursing Homes groups facilities in a given state or city into tiers by overall star rating - all five-star homes, all four-star homes, and so on. Homes too new to receive an overall rating appear below one-star homes. Within tiers, homes are listed alphabetically. The data foundation for Best Nursing Homes 2014 came from the federal Centers for Medicare & Medicaid Services in January 2014. CMS oversees federal payments to nursing homes and assigns the star ratings described above. 

On Best Nursing Homes, users can limit their searches in various ways, for example by distance or religious affiliation.

Which facilities did best in 2014?
In January 2014, 3,867 nursing homes earned an overall rating of five stars. Their profiles on usnews.com display a badge recognizing this status. U.S. News will periodically update its ratings and other data during 2014 as new data become available from CMS, but only those homes recognized in January will display a badge throughout the year. 

How are health inspections, nurse staffing and quality measures evaluated?
Health inspections. Because almost all nursing homes accept Medicare or Medicaid residents, they are regulated by the federal government as well as by the states in which they operate. State survey teams conduct health inspections on behalf of CMS about every 12 to 15 months. They also investigate health-related complaints from residents, their families and other members of the public. "Health" is broadly defined. Besides such matters as safety of food preparation and adequacy of infection control, the list covers such issues as medication management, residents' rights and quality of life, and proper skin care. A rating in this category is based on the number of deficiencies and their seriousness and scope, meaning relatively how many residents were or could have been affected. Deficiencies are included if they were identified during the three latest health inspections and in investigations of public complaints in that time frame. State inspectors also check for compliance with fire safety rules, although their findings are not factored into the CMS ratings. Best Nursing Homes displays all health and fire inspection results online. 

Nurse staffing. CMS determines the amount of time per day patients receive from the nursing staff, because even first-rate nurses and nurse aides can't deliver quality care if there aren't enough of them. The information is self-reported by each nursing home. Facilities report the average number of registered nurses, licensed practical nurses, licensed vocational nurses and certified nurse aides and assistants on the payroll during the two weeks before the latest health inspection. The number of hours they worked is also reported. Agency temporary employees do not count. That information is compared with the average number of residents during the same period and crunched to determine the average number of daily minutes of nursing time. To receive five stars in the latest CMS ratings, the nursing staff had to provide nearly 4½ hours of care a day to each resident, including about 43 minutes from registered nurses. The time for each home is shown in the ratings. CMS also provides the average time physical therapists spend with residents, but it isn’t factored into the staffing rating. 

Quality measures. CMS requires nursing homes to submit clinical data for the latest three calendar quarters detailing the status of each individual Medicare and Medicaid resident in 18 indicators, such as the percentage of residents who had urinary tract infections or who were physically restrained to keep from falling from a bed or a chair. Best Nursing Homes, like Nursing Home Compare, displays all 18 data points for each home. The ratings, however, are based on nine of them - seven for long-term and two for short-term residents - that are considered the most valid and reliable, such as the two above and other measures related to pain, bedsores, and mobility.

Are nursing homes rated the highest necessarily the best choice?
No. CMS is adamant in cautioning that all ratings, whether good or bad, are just a starting point, and we agree. Nothing takes the place of in-depth visits. You can ask questions, observe residents and their families and caregivers, and get a feel of a home that stars can't communicate. The CMS says on its website that "there are many satisfied residents and families of residents in nursing homes ... at the one-star level." And CMS cautions that "no resident should be moved solely on the basis of a nursing home's ratings.... [Transferring] your loved one to a facility that has a higher rating should be balanced with the possible challenges of adjusting to a new nursing home." That is one of many hard truths about finding a home where someone you hold dear can find good care. 

[Read and download a checklist of Questions to Ask on a Nursing Home Visit.]

Were there changes to the Best Nursing Homes 2014 methodology?

[Read Second Opinion Blog: Five-Star Homes More than Double in Five Years.]

How can I get a list of all five-star homes in a particular state, metro area or region?
Email your request to health-pr@usnews.com to receive a PDF file with tables breaking down all five-star nursing homes in the U.S. by metro area and region.

Why doesn’t U.S. News rate retirement or assisted-living communities?
Good data that would allow us to do that are not available. CMS does not regulate retirement or assisted-living communities, since their cost is not covered by Medicare or Medicaid, and U.S. News does not evaluate them or include them in the Best Nursing Homes database. 

[Read How to Choose a Nursing Home.]

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