How to Read Nursing Home Ratings and Rankings
Nursing home ratings can be confusing. There are CMS star ratings, Newsweek rankings, AHCA quality awards, US News rankings, and dozens of third-party review sites — each measuring something different. This guide explains what each rating system measures, how they compare, and how to use them together to make a smart decision for your family.
CMS Five-Star Quality Rating System
The most authoritative nursing home rating is published by the Centers for Medicare and Medicaid Services (CMS) through its Care Compare tool. Every Medicare-certified nursing home in the country receives a star rating from 1 to 5 stars in three categories:
Health Inspections (1-5 stars)
Based on state survey results from the past three years. Inspectors visit unannounced and evaluate compliance with hundreds of federal regulations. Fewer and less severe deficiencies earn higher scores. This is the most “objective” measure but can be affected by a single bad inspection cycle.
Staffing (1-5 stars)
Measures registered nurse hours and total nurse staffing hours per resident per day. Higher ratios generally mean more individualized care. CMS also measures the consistency of RN staffing — facilities that rely heavily on agency nurses score lower.
Quality Measures (1-5 stars)
Tracks 27 clinical quality measures including hospitalization rates, fall rates, pressure injury rates, and for short-stay patients: discharge-to-home rates and re-hospitalization rates. This is often the most meaningful measure for families choosing a short-term rehab facility.
Overall Rating
A weighted combination of the three component ratings. A 5-star overall rating indicates consistent performance across all three areas.
Limitation: CMS ratings can lag — data is typically 3-12 months old. A facility that has improved significantly recently may still carry a lower historical rating.
Newsweek Best Nursing Homes Rankings
Newsweek publishes an annual list of America’s Best Nursing Homes using a methodology developed with Statista that combines:
- Peer recommendations from doctors, nurses, and hospital discharge planners
- CMS quality measures data
- Patient satisfaction data
Being named to Newsweek’s list is significant because it reflects both clinical quality data AND the professional reputation of the facility among local healthcare providers — the people who see nursing home outcomes firsthand.
Scenic Nursing and Rehabilitation Center was named to Newsweek’s Best Nursing Homes 2025 list.
AHCA/NCAL Quality Award Program
The American Health Care Association Quality Award is a rigorous, voluntary recognition program based on the Baldrige Excellence Framework. It has three levels:
- Bronze: Demonstrates foundational quality improvement processes
- Silver: Demonstrates systematic, results-oriented quality improvement with measurable positive trends
- Gold: Demonstrates exceptional outcomes and serves as a national role model
Unlike CMS ratings, the AHCA award requires facilities to actively apply and submit to third-party review of their quality improvement processes. Only a small percentage of facilities earn Silver or Gold recognition.
Scenic earned the AHCA Silver Quality Award in 2024.
US News Best Nursing Homes
US News publishes an annual Best Nursing Homes ranking based primarily on CMS data, with additional weighting for short-term rehabilitation performance. It is a useful secondary source for identifying consistently high-performing facilities.
Third-Party Review Sites
Sites like Caring.com, SeniorAdvisor.com, and A Place for Mom collect reviews from residents and family members. These provide qualitative insight — the lived experience of care — that CMS data cannot capture. However, reviews can be skewed by very positive or very negative outliers.
How to Use Multiple Ratings Together
The strongest nursing home candidates will perform well across multiple independent measures:
- 4-5 stars on CMS Care Compare (especially quality measures)
- Newsweek Best Nursing Homes recognition
- AHCA quality award (Bronze, Silver, or Gold)
- Strong reviews on Caring.com or SeniorAdvisor
Scenic Nursing and Rehabilitation Center in Herculaneum, MO has earned recognition across all of these systems — a rare distinction that gives families strong confidence in the quality of care provided.
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