America’s Best Nursing Homes: How We Decide

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Finding a good, caring home is no trivial matter. We’ve taken government data and made it easier to use
By Avery Comarow

Posted July 2, 2009
In a typical year, about 3.2 million Americans will spend at least some time in a nursing home. To help find a good choice from among the nation’s more than 15,500 homes, U.S. News created America’s Best Nursing Homes. All data and other information are updated quarterly. The new update is effective as of July 1.

 At the core of the rankings is the data and ratings found on Nursing Home Compare, a federal website created by the Centers for Medicare and Medicaid Services. The CMS collects and analyzes information on almost all nursing homes—all that accept Medicare or Medicaid residents—and rates the facilities on numerous measures, from safe food preparation to the amount of nursing care per resident. We added major features to boost reliability, speed, and flexibility in searching for the right home. An Honor Roll lists homes at the very top of the heap.

CMS freely acknowledges that its rating and tracking systems could be better. Homes are given an overall rating of one to five stars, based on how well they measure up in three major areas (described below), which also are scored from one to five stars. One star means far below average, five stars far above average. Users can search for a specific home or for all homes in a certain location, such as within a state or a certain distance from a city or ZIP code.

One problem, however, is the large number of homes within each star rating—1,909 five-star and 3,725 four-star homes, for example. With so many, you can’t assume that the quality of all of the homes with the same overall rating is about the same. A second drawback is that search terms cannot be combined if, say, you want to look only for five-star homes within 50 miles of a specific city. And a third difficulty is that if you’re not sure of the name of a home or where it’s located, you have to plow through long lists of homes in likely cities (all those Goshens and Middletowns!) or a state or a region, one by one, until you hit your target.

The Best Nursing Homes rankings resolve these and other issues. For a more precise indication of quality, we created tiers within each star rating based on the total number of stars in all three of the categories CMS uses as yardsticks: health inspections, nurse staffing, and individual quality measures. The topmost tier of five-star homes, for example, consists only of homes that got 15 stars across the three yardsticks, the highest number possible; they make up the Honor Roll. Of all 15,557 CMS-rated nursing homes, 41 made the Honor Roll in the latest update. The next tier down is comprised of five-star homes with 14 stars in the three yardstick categories, and so on. Note that within tiers, homes are ordered alphabetically, not ranked.

You can also combine different search approaches. If initially hunting by state, region, city, or ZIP code turns up too many homes, the results can be winnowed to homes with a religious affiliation, for example, or ones that accept Medicare residents. Or a new, multifaceted search can be launched for, say, religiously affiliated five-star homes within 50 miles of a particular city that take Medicare.

We also extend a helping hand. Suppose you’re not positive you’ve got the right name of a home, or you’ve forgotten where it is. On our search page, you don’t need the precise location. If you enter as much of the name as you remember and click on Search, you’ll get a matching list of homes in all parts of the country. Typing "Sun" and hitting Search, for example, yields about 200 homes with "sun" somewhere in the name (Sunrise, Sunset, Sunny…). If you want all of the homes in a specific city, just starting typing the city name. After a few characters, a list of cities whose names start with those letters appears. Entering "mid," say, brings up an assortment such as Middleboro and Middletown. You can click on any of them to find homes there.

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