The Best Nursing Homes in the United States

Homes with the abuse icon () in the table have been identified by CMS as either being nursing homes where abuse has been reported or where abuse is likely based on multiple inspection reports.

What Makes a Skilled Nursing Facility One of the Best Nursing Homes, How to Use Our Database of the Best Nursing Homes

Every month we rank all of the skilled nursing facilities in the United States. The rankings for nursing homes are based on extensive metrics that are provided by The Centers for Medicare & Medicaid (“CMS”). The metrics include the CMS 5-Star Rating System which rates skilled nursing facilities using a rating system of five stars, where one star is the lowest and five stars is the highest rating. The rating system also rates nursing homes across five different dimensions including overall rating, health inspection rating, quality measures rating, overall staffing rating, and RN staffing rating (RN is an acronym for Registered Nurses).

In addition to the 5-Star Rating System, CMS provides numerical metrics that summarize:

• Health Inspection Data. CMS provides four numerical metrics related to the most recent health inspection surveys. These values, also known as “cycle scores”, are a distillation of detailed surveys conducted by a team of inspectors over a multi-day period. A score of each of the three most recent periods is provided along with a weighted score which is a combination of the three periods weighted towards the more recent periods. CMS estimates that more than 400,000 data points are used to calculate the four health inspection scores.
• Nursing Hour Statistics. Using multiple reporting methods, CMS calculates the amount of time that the nursing staff spends with residents. This is measured across multiple dimensions, one each for three different levels of nursings, including Registered Nurses (“RNs”), Licensed Practical Nurses (“LPNs”) and Certified Nursing Assistants (“CNAs”), plus one metric that totals all contributions. These metrics are expressed in hours per resident per day. CMS also provides state-level and national averages for the metrics to allow for additional comparisons.
• Abuse Flag. Abuse is always a concern in skilled nursing facilities. To highlight the issue, CMS has extracted this feature as its own flag. Facilities with an actual abuse event or where the potential for abuse has been shown for the past two years are flagged. The Health Inspection Score is capped at 2-stars for nursing homes that have been flagged for abuse.

Skilled nursing facilities that are new and do have at least two surveys completed are not rated by CMS. These facilities may have health inspection scores which can be used to evaluate the facility.

While this may seem like a lot of information,it has some drawbacks. The most significant problem is that when CMS calculates its 5-Star Rating, it does so based in part on state-level rather than national level data. Specifically, the health inspection star rating, which is the basis for the overall rating, is based on how a skilled nursing facility performs within the state not nationally. The top 10 percent of nursing homes with the lowest weighted health inspection score are given a 5-star rating. What qualifies for this cut varies from state to state (take a look at this cut-rate analysis by state).

What has also become problematic is that the frequency of nursing home inspections has declined since the beginning of the Covid pandemic. Inspections should be performed at least once every 12 months. CMS admits that in "rare cases" this could slip to 15 months, but our analysis suggests that the lag time between inspections is longer. This report shows that the lap time is now just under 500 days (or more than 16 months). There are also now hundreds of skilled nursing homes that have not been inspected in more than 24 months. This list shows the skilled nursing homes with the longest period since being inspected. According to the CMS data these homes have not been inspected since 2018!

The rating system is also biased against new nursing homes. An overall rating is not awarded until a nursing home has gone through two annual inspections meaning that at least two years and likely more time passes before we can use the 5-Star system with a nursing home.

While the cut-points for the health inspection ratings may change from month to month, the rating for a given skilled nursing facility is held constant until there is a change in the weighted health inspection score for that nursing home.

Other Interesting Lists About Nursing Homes Compiled by NursingHomeDatabase

• Worst Nursing Homes
• Newest Nursing Homes
• Nursing Home Ratings Upgrades
• Nursing Home Ratings Downgrades
• Nursing Home Most recent Inspections
• Nursing Homes with the longest time since being inspected
• CMS Scores Required for Nursing Home Five Star Ratings
• Nursing Homes with the Highest Nursing Time Spent per Patient
• Nursing Homes with the Lowest Nursing Time Spent per Patient