The Worst Rated Nursing Homes in the United States

Finding the Right Nursing Home: Why It Matters

When it comes to choosing a nursing home for your loved ones, it's crucial to have access to accurate and comprehensive information. Our worst rated nursing homes lists aim to provide you with insights into the facilities that have fallen short in various aspects of care. Understanding these ratings can help you make more informed decisions and ensure the well-being of those who matter most.

Top 10 Worst Nursing Homes in the United States

Our national rankings highlight the nursing homes that have received the lowest quality scores based on a variety of factors, including health inspections, staffing levels, and resident care. These scores are designed to give you a clear picture of which facilities may require closer scrutiny.

Factors Considered:

• Health and safety inspections
• Staffing ratios
• Resident care and outcomes
• Compliance with federal and state regulations

Our scoring methodology is transparent and designed to provide an unbiased look at each facility's performance (see below).

Disclaimer: Our rankings are based on data collected from reputable sources, including government reports and independent evaluations. While we strive for accuracy, we encourage you to visit facilities and conduct your own research before making any decisions.

Explore the Worst-Rated Nursing Homes by State

Every state has its own set of challenges and standards when it comes to nursing home care. To help you find the information most relevant to your location, we've compiled state-specific rankings of the worst-rated nursing homes. Click on the links below to explore the detailed lists for each state.

Related Lists and Resources

While it's important to be aware of the lowest-rated facilities, we also provide resources to help you find the Worst care available. Check out our other lists to find top-rated nursing homes and facilities that excel in specific areas.

Making Informed Decisions

Understanding our rankings and how they are derived can empower you to make better choices for your loved ones. Remember, a low rating in one area doesn't necessarily mean a facility is entirely unsuitable; it's a starting point for further investigation.

Tips for Evaluating Nursing Homes:

• Schedule visits to potential facilities
• Speak with staff and residents
• Review recent inspection reports
• Consider the specific needs of your loved one

Disclaimer: This is data that we pull primarily from the Centers for Medicare & Medicaid. We are not in touch with any skilled nursing facility and are not compensated by any facility.

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