Nursing Homes: What the Data Shows

What Is This Type of Facility

A recovery unit and a permanent home operating as a single facility.

A nursing home is a Medicare- and Medicaid-certified facility that provides 24-hour skilled nursing care. But the single label covers two populations whose situations — and whose needs — are quite different.

The first group arrives after a hospitalization. They had surgery, a stroke, a fall. They are not ready to go home, but they do not need a hospital bed. They come to a nursing home's skilled nursing unit to receive therapy and medical management while they recover. Most of them expect to leave. CMS refers to these residents as short-stay.

The second group has moved in. Their medical needs or cognitive decline require ongoing care that cannot be provided at home — and for many, this facility is now home. They are not here to recover and leave. CMS refers to these residents as long-stay.

This distinction matters because the federal government measures each group separately. A short-stay resident who returns to the hospital within 30 days of discharge is a very different event from a long-stay resident who develops a pressure injury. The data reflects that difference — and so does the way we surface it.

The Five-Star Rating

A single rating derived from three independent components.

Every nursing home participating in Medicare receives a Five-Star Quality Rating published on Medicare.gov. It is the most widely recognized quality signal in post-acute care — the first thing a family member sees when they start researching a facility for a loved one. But a single composite number compresses a great deal of complexity, and knowing what feeds it changes how you read it.

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The Overall Rating is a composite of three independent components — each weighted differently.

A facility can hold a 5-star overall rating while performing poorly on one component. The reverse is also true.

Component 1

Quality Measures

Based on a subset of MDS-derived clinical quality measures across both long-stay and short-stay populations. These include things like the rate of falls with major injury, pressure ulcer prevalence, antipsychotic medication use, and residents' ability to move independently. Each measure is scored against national and state benchmarks.

Component 2

Health Inspection

Based on the three most recent standard inspections and complaints over the past three years. Scores are weighted so that the most recent cycle matters most. This component carries the most influence over the overall rating — a facility with a history of serious deficiencies cannot paper over it with good staffing numbers.

Component 3

Staffing

Based on case-mix adjusted nursing hours per resident per day — RNs, LPNs, and aides — plus weekend staffing. The case-mix adjustment is important: a facility serving medically complex residents is expected to staff at higher levels, and the rating accounts for that. Turnover data is incorporated separately.

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MDS Quality Measures

The Minimum Data Set is a clinical assessment completed by nursing home staff for every resident at admission and at regular intervals throughout their stay. It captures detailed information about a resident's physical function, cognition, mood, and medical status — and the patterns in that data become the quality measures. Because MDS is completed for every resident at every facility, coverage is comprehensive and the measures reflect actual care delivery rather than billing records.

Because the short-stay and long-stay populations are so different in their needs and expected trajectories, CMS scores each group separately. A short-stay resident being rehospitalized is a different clinical story than a long-stay resident developing a pressure injury — the measures are designed to capture each.

Long-Stay Residents

People who live at the facility — measured on chronic condition management, functional decline, medication safety, and quality of life over time.

Falls with major injury
New or worsening pressure injuries
Antipsychotic medication use
Antianxiety or hypnotic medication use
Physical restraint use
Depressive symptoms
Need for help with daily activities (ADL decline)
Worsening ability to walk independently
New or worsened bowel or bladder incontinence
Catheter inserted and left in bladder
Urinary tract infection rate
Unintended weight loss
Pneumococcal and seasonal influenza vaccination
Number of hospitalizations per 1,000 resident days
Number of outpatient ER visits per 1,000 resident days

Short-Stay Residents

Post-acute residents recovering from a hospitalization — measured on whether they improved, whether they were discharged home, and whether they ended up back in a hospital.

Rehospitalization within 30 days of nursing home admission
Outpatient emergency department visit rate
New antipsychotic medication use
Pneumococcal and seasonal influenza vaccination
Four-quarter average scores and individual quarterly scores for each measure

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Health Inspections & Citations

State surveyors conduct unannounced physical inspections of every Medicare-certified nursing home — walking the hallways, reviewing records, interviewing residents and staff. When they find a problem, they cite it. That citation — the specific regulation violated, the severity of the harm, and whether the facility corrected it — is public record.

This is the only provider type in our platform where we surface the actual citation record, not just a score derived from it. A summary rating tells you how a facility compared to others. The citation record tells you what was wrong.

B – D No actual harm — potential for minimal harm through immediate jeopardy

E – G Actual harm — ranging from no immediate danger to immediate jeopardy

H – J Immediate jeopardy — widespread pattern affecting multiple residents

K – L Immediate jeopardy at the highest severity — serious injury or death

Health deficiency tag, category, and description
Scope and severity code per citation
Correction status and correction date
Standard, complaint, and infection control survey types
Three inspection cycles — most recent through 36 months prior
Civil monetary penalty amount per enforcement action
Payment denial start date and duration in days

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Staffing

Staffing data covers not just how many hours are worked, but how those hours hold up on weekends — when supervision is lighter and residents are most vulnerable — and how often staff leave.

Reported nurse aide hours per resident per day
Reported LPN and RN hours per resident per day
Total nursing hours — aide + LPN + RN
Weekend total nursing hours per resident per day
Weekend RN hours per resident per day
Physical therapist hours per resident per day
Case-mix adjusted staffing — accounts for resident acuity
Total nursing staff turnover rate
RN-specific turnover rate
Administrator turnover — number who left in the reporting period

Beyond the Rating

Three additional programs that the Five-Star rating doesn't capture.

The Five-Star rating is a starting point, not a conclusion. These programs measure aspects of nursing home performance that sit entirely outside it — expanding the picture beyond what any composite rating can show.

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SNF Quality Reporting Program

Skilled nursing facilities participating in Medicare are required to report quality data under the SNF Quality Reporting Program. These measures go beyond the MDS — adding functional outcome scores, infection rates, and medication safety measures that reflect the quality of the post-acute care episode more broadly.

Functional ability at discharge — self-care score
Functional ability at discharge — mobility score
Combined discharge function score
Falls with major injury during SNF stay
New or worsened pressure ulcers or injuries
Healthcare-associated infections requiring hospitalization (risk-standardized)
Potentially preventable 30-day readmission rate (risk-standardized)
Discharge to community rate (risk-standardized)
Drug regimen review with follow-up on identified issues
Medication list provided to next care setting at discharge
Medication list provided to patient and family at discharge
Medicare spending per beneficiary
COVID-19 vaccine status — residents and health care personnel
Influenza vaccination — health care personnel

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SNF Value-Based Purchasing

The SNF Value-Based Purchasing program ties quality performance directly to Medicare payment. Four measures determine a facility's performance score, which is then converted into an incentive payment multiplier applied to all Medicare Part A reimbursement for that fiscal year.

30-day all-cause readmission rate — baseline and performance period
Healthcare-associated infections requiring hospitalization — baseline and performance period
Total nursing staff turnover — baseline and performance period
Total adjusted nursing hours per resident day — baseline and performance period
Achievement score and improvement score for each measure
Overall performance score (0–100)
Incentive payment multiplier — applied to Medicare Part A payments
National ranking among eligible facilities

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Fire Safety & Emergency Preparedness

Fire safety inspections are conducted separately from health inspections and follow the Life Safety Code, a national standard for building safety in healthcare settings. Citations cover sprinkler systems, fire alarms, corridor walls and doors, egress, emergency power, and evacuation planning. Emergency preparedness — the facility's ability to respond to disasters and protect residents — is also inspected and cited under a separate tag series. Neither program influences the Five-Star rating.

Fire safety deficiency tag, category, and description
Emergency preparedness deficiency tag and description
Correction status and correction date
Three inspection cycles — most recent through 36 months prior

About the Data

Where the data comes from and how often it is updated.

All quality data for nursing homes is published by the Centers for Medicare and Medicaid Services through the Provider Data Catalog. Facilities participating in Medicare and Medicaid are required to submit this data — coverage is broad across the approximately 14,700 currently active certified nursing homes in the United States.

The data is updated quarterly. MDS quality measures and staffing data reflect rolling 12-month collection windows and are refreshed each quarter. The claims-based SNF QRP measures — readmissions, discharge to community, and Medicare spending — are based on 24 months of data and refreshed annually. SNF VBP performance data is published once per fiscal year. The full inspection history — citations, correction dates, and penalty records — is updated monthly and covers the three most recent inspection cycles.

The ownership record, which documents the individuals and organizations with ownership or management control over each facility, is separately maintained and updated. For facilities that are part of a chain, CMS also publishes chain-level average star ratings, making it possible to assess whether quality patterns are facility-specific or systemic across an ownership group.