Health inspections, nurse staffing and quality of medical care determined each home's star ratings.
Nursing-home care can be as short as a few days or weeks after a hospitalization or for years if aging family members can no longer live on their own. To help find the best match for a loved one, U.S. News has evaluated nearly 16,000 facilities across the country. This FAQ explains the evaluations and responds to questions often posed by media and health care professionals.
Where can I find the ratings?
Nursing Home Finder allows you to search for a home by Name, State, City or ZIP code. Nursing Homes by Location allows you to select a state or metro area for your search. Nursing Homes Search allows you to search for a nursing home by name or location and to filter by home size, overall rating and more.
Why does U.S. News rate nursing homes?
On any given morning this year, roughly 1.4 million individuals, including 1 in 10 individuals ages 85 and above, will wake up in a U.S. nursing home. We want to help families find a good and caring facility.
When did U.S. News begin rating Nursing Homes?
U.S. News began publishing ratings of nursing homes online in 2009. Until the current release, the tool reflected a snapshot of star ratings posted on Nursing Home Compare (https://www.medicare.gov/nursinghomecompare), the consumer website administered by the federal Centers for Medicare & Medicaid Services, or CMS. CMS assigns an overall rating of one to five stars to nursing homes according to their performance in three areas, or domains - state-conducted health inspections, nurse staffing and medical quality measures. Homes also receive CMS star ratings in each domain.
What is different about the current Nursing Home ratings?
Effective for 2016-17, U.S. News elected to modify the CMS ratings approach. This reflects a decision 1) to evaluate a nursing home's performance over time, by averaging monthly data over a year, 2) to place more emphasis on strong performance in medical quality measures by capping overall star ratings of homes with a low rating in this domain and 3) to call attention to homes, by capping their overall star ratings, that deliver only the bare minimum of rehabilitation therapy to most of the residents who receive high levels of rehabilitative services.
How are health inspections, nurse staffing and quality measures evaluated?
Health inspections. Because almost all nursing homes accept Medicare, Medicaid or both, they are regulated by the federal government as well as by the states in which they operate. State survey teams generally conduct health inspections on behalf of CMS every 12 to 15 months. They also investigate complaints from residents, their families and other members of the public that have a health basis, broadly defined. Besides matters such as safety of food preparation and adequacy of infection control, health covers issues such as medication management, residents' rights and quality of life and proper skin care. Ratings in this category are based on deficiencies and their seriousness and scope, meaning the relative number of residents who were or could have been affected. Deficiencies are included if 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. Nursing Home Finder displays all health and fire inspection results online.
Nurse staffing.CMS determines the daily time patients receive from the nursing staff, because even first-rate nurses and nurse aides can't deliver quality care if there are too few. 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 that is not factored into the staffing rating.
Quality measures. CMS requires nursing homes to submit clinical data for the latest three calendar quarters that detail the status of each individual Medicare and Medicaid resident in 18 indicators. Examples of these include 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 11 - eight for long-term and three for short-term residents - considered the most valid and reliable, such as the two examples cited above and other measures related to pain, bedsores and mobility.
How is the Nursing Home Finder organized?
Each nursing home receives an overall rating of one to five stars based on the number of stars it received over the course of the past 12 months 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 the District of Columbia are included. Best Nursing Homes orders and displays facilities in a given state or city by overall star rating - all five-star homes, all four-star homes and so on. Homes that are too new to receive an overall rating appear below one-star homes. Homes with the same score are listed alphabetically or by distance depending on the type of search.
On Nursing Homes Search, users can filter and sort their searches in various ways, for example by distance or whether a home is part of a continuing care community.
What is the source of the data?
Data for the ratings in the Nursing Home Finder for 2016-17 came from the federal Centers for Medicare & Medicaid Services, which oversees federal payments to nursing homes. The final month of data included in the ratings was released in October 2016.
Which facilities are listed on the Nursing Home Finder?
Nursing Home Finder profiles each of the nearly 16,000 U.S. skilled nursing facilities that appeared in October 2016 data posted by CMS. All of those homes accepted residents covered by Medicare, Medicaid or both.
Which facilities did best in 2016?
In the U.S. News evaluation for 2016-17, 2,005 nursing homes earned an overall rating of four and half stars and above to qualify as a U.S. News Best Nursing Home. Their profiles on usnews.com display a badge recognizing this status.
Are the highest-rated nursing homes 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. 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.
Why doesn't U.S. News rate retirement or assisted-living communities?
The cost of living in retirement or assisted-living communities is not covered by Medicare or Medicaid so they are not regulated by CMS; good data that would make evaluation possible are therefore unavailable.