How we rank nursing homes
How we rank assisted living communities
Five weighted categories.
Every weight below corresponds to data points visible in our facility comparison tables. Nothing evaluated that families can’t see.
Bar widths reflect weighting. Hover any category below for the full data inventory.
Care Quality
The largest single share of every ranking. These measures come from CMS Care Compare and reflect the actual care delivered to residents.
What’s measured
- Overall CMS Star Rating
- Health Inspection Rating
- Quality Measure (QM) Rating
- Long-Stay QM Rating
- Short-Stay QM Rating
Staffing Adequacy
Staffing is the single strongest predictor of resident outcomes in skilled nursing. We evaluate both volume and stability.
What’s measured
- Staffing Star Rating
- Nurse Hours Per Resident Per Day
- RN Hours vs State Average
- Total Nurse Staff Hours/Resident/Day vs State Average
- Registered Nurse Turnover
- Nurse-to-Resident Ratio
- Staff-to-Resident Ratio
Regulatory & Safety Record
Inspection history reveals patterns that star ratings can mask. We weight per-inspection rates more heavily than raw counts to avoid penalizing facilities inspected more often.
What’s measured
- Total Health Citations
- Citations Per Inspection (vs state average)
- Severe Citations (immediate jeopardy / high-harm)
- Penalties & Fines Received
- Accreditations (Joint Commission, CARF, AAAHC)
Operational & Financial Stability
Stable operations and sound finances are leading indicators of consistent care. Facilities under acute financial pressure cut staff, defer maintenance, and post higher turnover.
What’s measured
- Occupancy Rate (vs state average)
- Average Length of Stay
- Total Revenue (Medicare Cost Report)
- Payroll as % of Revenue
- Revenue Per Bed
- Ownership / Chain Affiliation
- Administrator Tenure
- Years in Operation
Environment & Accessibility
Context that matters to families but doesn’t directly measure clinical care. Weighted lower for nursing homes than for assisted or independent living, since most skilled-nursing residents do not access the surrounding neighborhood independently.
What’s measured
- Walk Score
- Better Business Bureau Rating
Data sources
All inputs are sourced from publicly verifiable datasets. We do not rely on self-reported facility marketing claims.
CMS Care Compare
Provider Information dataset — star ratings, quality measures, and federal inspection results. Updated monthly by CMS.
CMS Payroll-Based Journal (PBJ)
Verified staffing hours and turnover data, submitted by facilities and audited by CMS. The gold standard for nursing home staffing measurement.
CMS Health Deficiencies dataset
Federal inspection citation records, including severity classifications for immediate-jeopardy and high-harm findings.
CMS Medicare Cost Reports (HCRIS)
Audited annual financial reports filed with CMS — revenue, payroll, and other operational financials.
State licensing databases
State-by-state licensing records for administrator tenure, chain affiliation, and operating history.
Accreditation directories
Verified accreditation status from The Joint Commission, CARF, and AAAHC.
Walk Score
Walkability scoring API for the facility address, measuring proximity to amenities and pedestrian access.
Better Business Bureau
BBB business profiles, including accreditation status, complaint history, and customer review patterns.
Six weighted categories.
Every weight below corresponds to data points visible in our facility comparison tables. Nothing evaluated that families can’t see.
Bar widths reflect weighting. Hover any category below for the full data inventory.
Resident & Family Experience
The single largest share of every ranking. We aggregate review data across multiple platforms to capture how families and residents actually experience the community.
What’s measured
- Average Review Sentiment
- Volume of Reviews
Regulatory & Safety Record
State inspection records are the closest equivalent to CMS data for non-skilled-nursing communities. We weight per-inspection rates more heavily than raw counts to avoid penalizing communities inspected more frequently.
What’s measured
- Number of State Inspections
- % of Inspections with Citations
- Total Citations / Violations
- Citations per Inspection
- Number of Complaint Visits
- Awards and Accreditations
- Better Business Bureau Rating
Visual Media & Transparency
Communities that publish high-quality visual media give families a real preview of the environment. Communities with no photos or tours receive a negative transparency signal.
What’s measured
- Presence of Video Tours
- Matterport / Virtual Walkthroughs
- Photo Quantity
- Photo Quality
Website & Operator Transparency
A community’s website is often the first touchpoint for families. We score both the quality of the site and whether the operator publishes basic accountability information.
What’s measured
- Quality of Website Content
- Ease of Navigation & Mobile Usability
- Available Staffing Information
- Owner / Operator Transparency
Community Stability
Operational health indicators that signal whether a community is well-run and meeting demand.
What’s measured
- Occupancy Rate
- Bed Options Offered
Environment & Pricing
Context that supplements care quality. Walk Score is weighted differently across care types — higher for Independent Living, where residents access neighborhoods routinely; lower for Memory Care, where most residents do not leave unaccompanied.
What’s measured
- Walk Score (weighted by care type)
- Pricing Transparency
Data sources
All inputs are sourced from publicly verifiable datasets. We do not rely on self-reported facility marketing claims for scoring.
State health department inspections
Inspection counts, deficiencies, citations, and complaint visits. Sourced state-by-state from official health and human services agencies.
Third-party review platforms
Aggregated review sentiment and volume from Google, Yelp, Caring.com, A Place for Mom, and other major platforms.
Better Business Bureau
BBB business profiles, including accreditation status, complaint history, and customer review patterns.
Accreditation directories
Verified accreditation status from CARF, Joint Commission, and state-specific senior living credentials.
Walk Score
Walkability scoring API for the community address, measuring proximity to amenities and pedestrian access.
Community-published materials
Website content, video tours, virtual walkthroughs, photo galleries, staff directories, and pricing pages — audited by our editorial team.
How comparisons are computed
Every rank badge on the site (e.g. “12th of 34”) is a statewide comparison — not limited to whichever facilities happen to be shown on the page you’re viewing.
Same care type, same state
We keep four separate comparison pools per state — nursing home, assisted living, memory care, and independent living — and a facility is only ever ranked inside them. A nursing home is ranked against other nursing homes; an assisted living community against other assisted living communities. A community that offers several care types is ranked in each of the corresponding pools, and the badges you see are always the ones for the care type of the page you are on, so the denominator matches the comparison table around it. Care types we don’t rank — home care, hospice, respite, palliative, and adult day care — show no rank badges at all rather than borrowing another population’s.
Pool size varies by metric
Not every facility reports every metric, so the “of N” denominator differs from one badge to the next on the same profile. CMS federal filings — staffing hours, citations, fines, financial reports — exist only for Medicare/Medicaid-certified nursing homes that filed a report, so those pools are naturally smaller than physical attributes like bed count, Walk Score, or occupancy, which nearly every facility reports. We do not publish a rank at all when fewer than ten facilities of that care type in the state report the metric.
Ties share a rank
Facilities with the same value for a metric receive the same rank, and the next facility’s rank skips ahead accordingly — a competition ranking, not row order.
The ALM Inspection Grade
A 0–100 score and a letter, calculated by Assisted Living Magazine from a regulator’s published inspection record. It is a separate measure from the rankings above, with its own inputs. It is not a government rating: CMS and state health agencies publish the underlying records, and no regulator endorses or reviews the grade.
The letter is a rank, not a score threshold
A facility is compared with others of its own kind in its own state — Medicare-certified nursing homes against Medicare-certified nursing homes, state-licensed communities against state-licensed communities. The letter reflects where it falls in that group, so the same 0–100 score can carry different letters in different states, and a grade always answers “compared with what?” before it answers “how good?” The scale runs A+, A, A- through to F, 13 bands in all.
The categories depend on what the regulator publishes
Each state keeps its inspection record differently, so a grade is built from the categories that state actually publishes — how many findings an inspection turns up, how often an inspection turns up anything, complaint activity, the severity a state assigns its own citations, and formal enforcement actions. A facility is never marked down for a category its regulator does not keep. The grade card lists the categories used for that facility, each with the share of the grade it carries.
A thinner record moves the grade less
How much of the record we hold is measured alongside the grade itself. A facility whose record fills only part of the model has its result pulled back toward the middle, so a high grade cannot rest on a single category or a handful of inspections. Serious findings weigh more than clean marks, and a recent severe event can cap a grade regardless of the rest.
When no grade is shown
A missing grade reflects what we have been able to verify, not a judgement about the facility. We withhold one where the record is too thin to stand behind, where a facility’s state is not yet published, and where a grade would flatly contradict Medicare’s own inspection rating on the same page. Grades from state records are currently published in CA, NY, IN, NJ, CO, FL, TX, UT; facilities graded on the federal record are covered in every state.
Editorial independence is non-negotiable
Rankings are produced by our editorial team using the methodology above. Sales and partnership relationships have no influence on a facility’s ranking.
