FAQ: How We Rate Nursing Homes

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: overall care and short-stay rehabilitation. This FAQ explains the evaluations and responds to questions that nursing home residents, families, media and health care professionals may have about the U.S. News ratings.

Where can I find the ratings?

Nursing Home Finder allows you to search for a nursing facility by name, state, city or ZIP code.

Nursing Homes by Location allows you to select a state or metro area for your search.

Why does U.S. News rate nursing homes?

On any given morning this year, roughly 1.4 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 two ratings published by U.S. News, the Overall rating and the Short-Stay Rehabilitation rating, offer individuals and families a starting point in their search for a nursing home, whether they are interested in a facility’s overall care or specifically need short-term rehabilitation care.

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

Since its inception in 2009, the U.S. News 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. U.S. News assigns an overall rating to nursing homes that is based on their CMS-assigned star ratings in three areas or domains: state-conducted health inspections, nurse staffing and medical quality measures. For greater detail on the U.S. News methodology, click here.

Starting this year, U.S. News has added a Short-Stay Rehabilitation rating evaluating the care delivered to patients after a hospitalization for surgery, heart attack, stroke, injury or similar condition.

Which nursing homes were eligible for rating?

All Medicare- and Medicaid-certified nursing homes 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 an overall rating, a home must have received an overall star rating from CMS in July 2018 and a staffing star rating in either April or July 2018.

To be eligible for a short-stay rating, a home’s performance on at least one outcome measure and data on either physical therapy time or RN and total nurse staffing must have been available from CMS. Outcome measures included the percentages of short-stay patients who were rehospitalized within 30 days, had an emergency room visit within 30 days and were successfully discharged to their home or community.

What makes a facility a Best Nursing Home?

U.S. News assigned two separate ratings to most nursing homes: an Overall rating and a Short-Stay Rehabilitation rating. Facilities were considered Best Nursing Homes if they were rated high performing in either the Overall or Short-Stay Rehabilitation rating and not rated worse than average in the other. A total of 2,975 facilities were recognized by U.S. News as Best Nursing Homes — 1,837 in overall care and 1,874 in short-stay rehab. 736 nursing homes received this designation in both overall and short-stay care.

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

The U.S. News Overall ratings assign each eligible nursing home a rating of High Performing, Better than Average, Average, Worse than Average or Poor. This rating evaluates the care of a wide range of resident in the nursing home, including both long-term residents with chronic needs and short-term patients who receive rehabilitation following a hospital stay.

The data used to evaluate these homes come from the federal Nursing Home Compare program, and incorporate the nurse staffing, health inspection and quality measures star ratings. In addition to these measures, nursing homes were assessed on whether they had a patient-centered or billing-centered pattern in the number of minutes of therapy certain high-needs patients received. The consistency of their reported nurse staffing figures across assessment-based and payroll-based reporting systems was also a factor in the ratings.

The process for determining a nursing home’s Overall rating is described in further detail in the methodology report.

How and why did the overall rating change from previous years?

The CMS domain star rating for staffing, rather than its overall star rating, now serves as the foundation of the U.S. News Overall rating. This decision reflects expert opinion on the importance of staffing in quality of care, as well as the availability since April 2018 of more accurate data on nurse staffing levels in each facility. April was the month CMS’ published staffing data transitioned from a survey-based system for compiling data to a more accurate payroll-based data-collection system.

Whereas last year’s U.S. News rating was based on an average of 10 months of data from CMS, fewer months of data were used to determine the overall rating this year. This decision was based on two factors: 1) Staffing data from prior to the April transition to the payroll-based system were less accurate than more recent data; and 2) The CMS health inspection star ratings have been frozen since February 2018 as regulators roll out a new inspection survey. Restricting the analysis to fewer months of data therefore improves measure consistency, accuracy and reliability.

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

The Short-Stay Rehabilitation rating is based on nine quality measures focusing on staffing, outcomes, resident complaints and processes of care. 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 the skilled nursing facility.

The short-stay rating takes into account the training level of nursing staff, the amount of physical rehabilitation that patients received, all three outcome measures available, the percentage of patients who were appropriately vaccinated for influenza, how many resident complaints a home received, the stability of facility staffing and whether or not a home is delivering patient-centered rehabilitation therapy.

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

Where did the data come from?

All data used in the U.S. News Overall and Short-Stay Rehabilitation ratings came from publicly available sources published by CMS. The U.S. News Overall rating primarily employed the three domain star ratings published by CMS for state-conducted health inspections, amount of nurse staffing and measures of medical quality. The Short-Stay Rehabilitation rating used the underlying data that CMS aggregated in these domain ratings. Both U.S. News ratings further incorporated data from certain CMS public use files.

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

While the CMS rating that can be viewed on Nursing Home Compare prioritizes a facility’s health inspection star rating, the U.S. News Overall rating uses the staffing star rating as its base, making the staffing domain more important than it is in the CMS rating. Furthermore, U.S. News put less emphasis on CMS’ quality measures rating than CMS does because researchers and other experts have raised concerns about how meaningful some of CMS’ quality measures are. Lastly, U.S. News capped certain nursing homes ratings, preventing them from obtaining the highest available rating. A cap was applied, for example, if a facility exhibited a pattern of rehabilitation care that appeared to be billing-centered — that is, designed to maximize payments to the facility — rather than patient-centered.

The table below shows the concordance between the U.S. News Overall rating and the CMS overall star ratings published in July 2018 for all nursing homes that received a 2018-19 U.S. News Overall rating. More than 4,300 nursing homes received CMS’ top rating of five stars, while just 1,844 nursing homes earned the top Overall rating issued by U.S. News.

U.S. NEWS OVERALL (AT RIGHT),

CMS (BELOW)

Poor Worse than Average Average Better than Average High Performing Total
1 star 1,216 636 84 0 0 1,936
2 stars 1,015 1,045 839 198 1 3,098
3 stars 450 823 1,026 237 4 2,540
4 stars 145 491 1,395 1,158 251 3,440
5 stars 2 286 693 1,734 1,588 4,303
Total 2,828 3,281 4,037 3,327 1,844 15,317

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

No. All ratings, whether good or bad, are just a starting point. 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 said 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.

More from U.S. News

How to Help Aging Parents Manage Medications

7 Red Flags to Watch for When Choosing a Nursing Home

How to Prepare for Hip Replacement Surgery

FAQ: How We Rate Nursing Homes originally appeared on usnews.com

Update 10/30/18: This article was originally published on Feb. 26, 2014 and has been updated to reflect changes.



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