How We Rate Nursing Homes
Our methodology for analyzing Medicare data, calculating Trust Score, and helping families identify quality care.
What Is Trust Score?
Trust Score is our proprietary 0-100 rating that applies advanced analytical models to CMS data. While government star ratings give you a snapshot, our scoring system reveals deeper quality signals by weighing inspection severity, staffing consistency, clinical outcome trends, and enforcement patterns.
We've calibrated our models to surface the facilities that deliver consistently excellent care. Trust Score synthesizes multiple quality dimensions, with greater weight given to factors that our research shows are the strongest predictors of resident safety and outcomes.
Key factors in our model: Health inspection results and deficiency severity, staffing levels and consistency, clinical quality outcomes, enforcement history, and peer performance benchmarks. The exact weights and adjustment factors are proprietary, but we prioritize metrics that directly impact resident care quality and safety.
Data Sources
All data comes from the Centers for Medicare & Medicaid Services (CMS), the federal agency that inspects and certifies nursing homes. We analyze multiple CMS datasets:
| CMS Dataset | What It Measures |
|---|---|
| Health Inspection Rating | Deficiencies found during annual state surveys, severity classifications (scale 1-5 stars) |
| Staffing Rating | RN hours per resident per day, total nurse hours, staffing turnover (scale 1-5 stars) |
| Quality Measures Rating | Clinical outcomes: falls, pressure ulcers, UTIs, antipsychotic use, rehospitalization rates (scale 1-5 stars) |
| Overall CMS Star Rating | CMS's composite 1-5 star rating (used for reference and filtering) |
| Enforcement Actions | Fines, payment denials, terminations from Medicare/Medicaid, complaint-based surveys |
| Ownership & Operations | Ownership type (for-profit, nonprofit, government), bed count, address, operating history |
Our analytical approach: CMS provides 1-5 star ratings for each dimension. We apply proprietary normalization, severity adjustments, trend analysis, and penalty factors to compute Trust Score. Our models account for deficiency severity, enforcement patterns, and outcome consistency in ways that simple star averaging cannot capture.
Letter Grade Scale
We translate Trust Score into letter grades to make quality differences easier to understand at a glance:
These grades are relative to national performance. A "B" facility performs better than most homes nationwide, while an "A" represents top-tier quality.
When Data Is Updated
CMS updates nursing home data on a monthly cycle. We refresh our database within 48 hours of each CMS release, typically around the 1st of each month.
Each facility page displays the exact data refresh date at the bottom. If you see information that contradicts recent events (like a facility closure or change of ownership), the CMS data may not yet reflect that change. Updates typically lag real-world events by 30-60 days.
Inspection data timing: Health inspection ratings reflect the most recent annual state survey. If a facility was inspected 11 months ago, the current rating reflects that survey, not conditions today. CMS surveys each facility approximately once per year, with additional complaint-based surveys when issues are reported.
Questions about our methodology? Email listings@nursinghomedata.org. We're continuously refining our analysis methods and welcome feedback from families, facilities, and researchers.