Understanding Nursing Home Rating Guides

Nursing Home Rating Nursing home rating guides vary from those run by the Centers for Medicare & Medicaid Services (CMS) and Florida Agency for Health Care Administration, to rankings published by private companies, such as U.S. News. Navigating these ranking guides can be daunting, particularly if it is unclear which factors are weighed in the ranking system and any potential behavior that some homes might use to potentially (and artificially) inflate to their own rank.


The Florida Agency for Health Care Administration licenses and regulates the health care facilities in the state of Florida and administers Florida’s Medicaid Program. The agency also sets forth its own set of criteria that it sees as important in looking for the right nursing home:

  • 24-hour nursing care
  • Assistance with personal care
  • Accommodation of special nutritional needs
  • Physical therapy; health monitoring and supervision; social and creative activities; and respite care.

The agency also suggests that you pay attention to any specialized homes that address particular needs (such as treatment for Alzheimer’s), proximity of the home to family and friends, quality of the neighborhood, level of noise, compatibility with other residents, etc.

Nursing Home Compare (CMS)

Nursing Home Compare tracks Medicare and Medicaid-certified nursing homes all over the country with the intent of allowing consumers to compare information about the nursing homes, and includes over 15,000 nationwide. They base their ranking system on such factors as:

  • Annual health inspections;
  • Hours of care performed by staff;
  • Number of registered nurses, physical therapists, and nursing assistants;
  • Percentage of residents with pressure sores, urinary incontinence, and other issues relating to quality of care; and
  • Any penalties enforced against the nursing home.

CMS’ Guide to Choosing a Nursing Home or Other Long-Term Care provides information on how to find and compare nursing homes, how to pay for the homes, your rights as a resident, and existing alternatives to nursing homes. The guide recommends that you do your research on how CMS has rated the quality of the home, as well as visit the home and speak with neighbors, friends and family about their experiences and seek recommendations from doctors and/or senior community activity centers that you trust regarding potentially good or bad nursing homes in your area.

In February of this year, the star ratings of nearly a third of all nursing homes were lowered by CMS to improve their 5-star quality rating system and readjust quality standards in response to accusations that ratings were previously artificially inflated. Those in charge of rating nursing homes had, for some time, expressed the need to constrict and add more reliability to nursing home rankings systems that heavily rely on self-reporting of issues as a major component of their rank. This revision resulted in Nursing Home Compare 3.0, which adds the following factors into the rating system:

  • Ratios of use of antipsychotic drugs among residents;
  • Staffing levels;
  • Resident surveys; and
  • Improving quality measure data (resident assessment data collected by the nursing home).

Department of Elder Affairs

The state Department of Elder Affairs also provides a list of important questions and concerns to keep in mind in selecting a facility, such as what services they provide, what the contract looks like, if there is a written plan of care provided to family members, etc.

Public vs. Private Guides?

U.S. News, a private company, bases its own Florida ranking system on those homes that receive a five star rating from CMS, and reported that about 23 percent of all nursing homes in Florida earned a five-star rating, overall. Those that received the best ratings were Lake Eustis (Eustis), Arch Plaza (North Miami), River Garden (Jacksonville), Jupiter Medical (Jupiter), and Bayside (Saint Petersburg).

Other Resources

Brill & Rinaldi

If you think a loved one has been abused or neglected while under the care of a nursing home, or you have other questions or concerns related to nursing homes, it is advisable to contact a law firm with experience dealing in these types of cases. Brill & Rinaldi, The Law Firm has that experience in this area and knows how to help you and your loved ones. We offer a free initial consultation to help you determine how best to proceed.