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FAQ: How We Rate Nursing Homes

US News & World Report - Health logo US News & World Report - Health 10/27/2020 Zach Adams

Nursing home care can be as short as a few days or weeks after a hospitalization or it can be 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 evaluated more than 15,000 facilities throughout the country and rated most of them in two different areas, short-term rehabilitation and long-term care. This FAQ explains how nursing homes were evaluated and responds to questions that nursing home patients, residents, and families may have about the U.S. News ratings.

For more detailed information on how U.S. News Best Nursing Homes ratings were determined, the methodology report can be found here.

Where can I find the ratings?

Best Nursing Homes allows you to search for a nursing facility by name, state, city or ZIP code and filter based on ratings, size, and certain capabilities, such as memory care.

Nursing Homes by Location allows you to search by state or local area.

Why does U.S. News rate nursing homes?

On any given morning this year, over 1.3 million individuals, including 1 in 10 individuals age 85 and above, will wake up in a U.S. nursing home. The quality of care provided at the more than 15,000 U.S. nursing homes, also sometimes called skilled nursing facilities, varies widely. U.S. News wants to help families research facilities and find a nursing home that excels in the type of care they need. The U.S. News Best Nursing Homes Short-Term Rehabilitation, Long-Term Care and Overall ratings offer individuals and families a starting point in their search for a nursing home, whether they are in need of short-term rehabilitation care, long-term care, or are interested in a facility’s overall care.

When did U.S. News begin rating nursing homes?

Since their inception in 2009, the U.S. News Best Nursing Home ratings have relied on data from Nursing Home Compare, a program run by the Centers for Medicare & Medicaid Services, the federal agency that sets and enforces standards for nursing homes.

In 2018, U.S. News added a Short-Term Rehabilitation rating evaluating the care delivered to patients after a hospitalization for surgery, heart attack, stroke, injury or similar condition. In 2019, U.S. News added a Long-Term Care rating evaluating the care delivered to residents who are no longer able to live independently and need help with daily activities such as eating, getting in or out of bed or wheelchair, using stairs, or getting dressed, as well as administering needed medical care.

Which nursing homes were eligible for rating?

All Medicare- and Medicaid-certified nursing homes that were part of the July 2020 CMS nursing home provider census that was made available in July 2020 were evaluated by U.S. News. Nursing homes did not apply nor did they provide any data or materials to U.S. News.

To be eligible for a Short-Term Rehabilitation, Long-Term Care or Overall rating, a home must have met the following inclusion criteria:

  • Received reimbursement from CMS in July of 2020
  • Had sufficient data to evaluate quality in that rating

What makes a facility a Best Nursing Home?

Facilities were considered U.S. News Best Nursing Homes if they were rated ‘high performing’ in either Short-Term Rehabilitation or Long-Term Care. A total of 3,277 facilities were recognized by U.S. News in 2020 as Best Nursing Homes – 2,362 in Short-Term Rehabilitation and 1,623 in Long-Term Care. This year, 708 nursing homes received this designation for both stay types.


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Does U.S. News’ Overall rating methodology use measures from CMS’ star ratings methodology?

Because U.S. News calculates both a Short-Term Rehabilitation Rating and Long-Term Care Rating for each nursing home, beginning in 2019, we chose to use these as the foundation for the summary Overall score, rather than CMS-issued domain-specific star ratings. The U.S. News methodology does not incorporate any CMS-issued, domain-specific ratings, or the overall rating from the CMS five-star quality rating system. Furthermore, some measures used in the analysis for both Short-Term Rehabilitation and Long-Term Care ratings are not used in the CMS approach.

How did U.S. News determine its Short-Term Rehabilitation rating?

The Short-Term Rehabilitation rating is based on ten quality measures focusing on staffing, outcomes, resident complaints and processes of care. U.S. News used scientific literature review, expert consultation and statistical modeling to select these measures. This rating designates nursing homes as high-performing, average or below average in the care they provided to patients who spent 100 days or less at a skilled nursing facility.

For more detailed information on how this rating was determined, our methodology report can be found here.

How did U.S. News determine its Long-Term Care rating?

The Long-Term Care rating is based on U.S. News’s assessment of nine quality measures focusing on staffing, outcomes, resident complaints and processes of care. U.S. News used scientific literature review, discussions with industry experts and statistical modeling to select these measures. This rating designates nursing homes as high-performing, average or below average in the care they provided to residents who spent more than 100 days at a nursing home.

For more detailed information on how this rating was determined, our methodology report can be found here.

How did U.S. News determine its Overall Rating?

The U.S. News Best Nursing Homes assigns each eligible nursing home an Overall rating from 1 to 5. This rating evaluates a wide range of the care in the home, including both long-term residents with chronic needs and short-term patients who may receive rehabilitation following a hospital stay.

Each nursing home that was rated in Short-Term Rehabilitation, Long-Term Care, or both, received a U.S. News Overall rating. The Overall rating is based on a 5-point scale that averages the short- and long-term scores, weighting each equally, where High Performing receives a value of 5, Average receives a value of 3, and Below Average receives a value of 1. If a home was only eligible for one of the two component ratings, the Overall score reflected that rating.

For more detailed information on how this rating was determined, our methodology report can be found here.

How, if at all, has the coronavirus pandemic impacted U.S. News’ Best Nursing Homes methodology this year?

New this year, a Patient Safety Summary panel was added to each nursing homes’ U.S. News profile pages, intended to aid families in assessing a home’s efforts around patient safety. U. S. News does ot issue a patient safety rating, although some of the highlighted metrics do appear in the short and long term ratings methodologies. The patient safety summary rather serves to highlight the home’s performance on a number of measures compared to the local and national averages. Measures include vaccination rates, numbers of COVID-19 cases in both the resident and staff populations reported to date and for that home’s most recently reported week (updated regularly), as well as preventable patient falls, whether or not there have been infection violations in the most recent inspection cycle, and if a home is a Special Focus Facility or Candidate.

Where did the data come from?

All data used in the U.S. News Best Nursing Home ratings came from publicly available sources published by CMS. Data used in the Short and Long-Term ratings analysis were evaluated over time intervals that vary based on the particular component being measured. Data sources and time intervals are listed in Appendix A of the methodology report.

How can a nursing home's U.S. News rating be different from the rating on Nursing Home Compare?

The two rating systems use completely different methodologies. The CMS rating is based on CMS-assigned star ratings in several domains such as health inspections and quality measures. By contrast, the U.S. News Best Nursing Home ratings are based on the methods described above and do not use the CMS star ratings. Staffing data and performance on key outcome measures are more important in determining a nursing home’s U.S. News Best Nursing Homes rating than in the CMS star rating.

Are the highest-rated nursing homes necessarily the best choices?

No. In any industry there are multiple organizations that conduct ratings. These ratings organizations often differ on the criteria and the weighting of that criteria when assessing quality. Consumers of these ratings do, and should, consult multiple sources and conduct in-person evaluations before making decisions. The senior care industry is no different.

All ratings, whether good or bad, are just a starting point for healthcare consumers who are choosing where to receive care. 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 ratings can't communicate. CMS says on its website 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.

Copyright 2020 U.S. News & World Report

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