FAQ: How We Rate Nursing Homes
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?
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.
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.
How is Best Nursing Homes organized?
Each nursing home receives an overall rating of one to five stars based on the 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 the District of Columbia 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 that are too new to receive an overall rating appear below one-star homes. Within tiers, homes are listed alphabetically.
On Best Nursing Homes, users can limit their searches in various ways, for example by distance or religious affiliation.
What is the source of the data? Data for Best Nursing Homes 2015 came from the federal Centers for Medicare & Medicaid Services, which oversees federal payments to nursing homes, in February 2015. CMS assigned the star ratings described above.
Which facilities did best in 2015?
In February 2015, 3,392 nursing homes earned an overall rating of five stars. Their profiles on usnews.com display a badge recognizing this status. U.S. News periodically updates the ratings and other data as new data become available from CMS, but only those homes recognized in February will display a badge throughout 2015. U.S. News delayed the release of the 2015 ratings from January to February because of significant CMS changes in the methodology that produces star ratings. The changes took effect in February.
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. Best Nursing Homes 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.
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.
