Our guides are based on analysis of real CMS data from all 14,751 Medicare-certified nursing homes. We cut through the marketing fluff to give you actionable insights backed by statistics.

Featured Guides

12 min read

Based on analysis of 14,751 facilities, learn what CMS star ratings really mean and how to use them effectively.

Key Findings:

  • •Only 18.9% of facilities earn 5 stars
  • •5-star facilities have 50% more RN staffing
  • •100% of 5-star facilities are abuse-free
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10 min read

Why staffing is the #1 predictor of quality. Learn what RN hours, turnover rates, and nurse-to-resident ratios actually mean.

Key Findings:

  • •National average is just 0.64 RN hours/day
  • •High turnover (60%+) drops ratings by 1 full star
  • •Only 6% of facilities meet gold standard
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14 min read

46.8% average turnover nationally. 1-star facilities have 52.5% turnover vs 5-star at 39%. Learn why staff stability matters as much as staffing levels.

Key Findings:

  • •1-star facilities: 52.5% turnover vs 5-star: 39%
  • •High turnover (60-90%): 0% achieve 5-star rating
  • •Low turnover (<30%): 20% earn 5 stars
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15 min read

Small facilities (<50 beds) earn 5-star ratings 16x more often than very large ones. Why facility size impacts quality, safety, and personalized care.

Key Findings:

  • •Small facilities: 41.7% earn 5-star vs very large: 2.6%
  • •Abuse violations 11x higher in 200+ bed facilities
  • •5-star facilities average 88 beds vs 1-star at 120 beds
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15 min read

Understand the government database that tracks all 14,751 facilities. Learn what data is available, why it's more reliable than marketing or reviews, and exactly how to use it.

Key Findings:

  • •CMS tracks 100% of certified facilities with mandatory reporting
  • •7 data categories from staffing to safety violations
  • •Updated quarterly - more current than most sources
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16 min read

Based on 14,751 facilities: 26% of 1-star homes have abuse violations vs 0% of 5-star. Learn which facilities carry the highest risk and how to avoid them.

Key Findings:

  • •26.14% of 1-star facilities have abuse violations vs 0% of 5-star
  • •Very large facilities (200+ beds) have 10x higher abuse rate
  • •Low RN staffing correlates with 20% abuse rate
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14 min read

Based on analysis of 411,456 government deficiency citations, learn the red flags that predict serious neglect—and what to do if you see them.

Key Findings:

  • •5.6% of citations are immediate jeopardy
  • •Infection control is the #1 cited deficiency
  • •26.4% of 1-star facilities have abuse violations
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13 min read

Analysis of 14,751 facilities shows Hawaii ranks #1 (28.9% five-star), Louisiana ranks last (12.1%). See which states have the highest quality care.

Key Findings:

  • •Top 10 states average 51% more RN hours
  • •Quality varies 3x between best and worst states
  • •Regional patterns: Northeast/West best, South struggles
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14 min read

Nonprofit facilities have 2x higher 5-star rates (35% vs 18%), 22% more RN staffing, and 74% fewer abuse violations than for-profit nursing homes.

Key Findings:

  • •Nonprofits earn 5 stars twice as often (35.1% vs 17.5%)
  • •22% higher RN staffing in nonprofit facilities
  • •74% fewer abuse violations than for-profits
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18 min read

76% of nursing homes are chain-owned. Independent facilities have 29% higher 5-star rates—but chain quality varies wildly from 36% (Ensign) to 0% (Cambridge).

Key Findings:

  • •Independent facilities have 29% higher 5-star rates (23.9% vs 18.5%)
  • •Chain abuse violations 26% higher than independent
  • •Best chain (Ensign): 36.2% 5-star rate; Worst (Cambridge): 0%
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15 min read

Geographic location dramatically impacts nursing home quality. Urban facilities average 3.2 stars vs rural 2.9 stars, with major differences in staffing and specialized services.

Key Findings:

  • •Urban facilities: 3.2 avg stars vs Rural: 2.9 stars
  • •RN staffing 24% higher in urban areas (0.72 vs 0.58 hours/day)
  • •Urban 5-star rate: 21.4% vs Rural: 14.2%
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16 min read

~400 facilities nationwide are in CMS's Special Focus Facility program—intensive oversight for the worst 5%. Learn what triggers designation and whether facilities actually improve.

Key Findings:

  • •SFF facilities represent the worst 5% of nursing homes nationwide
  • •Only 40% successfully graduate; others close or change ownership
  • •3x higher rates of immediate jeopardy citations than average
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City-Specific Guides

Comprehensive guides to nursing home care in major U.S. cities, including real costs, quality analysis, and top-rated facilities based on 2025 CMS data.

Los Angeles Nursing Homes

80 facilities, 2.3 avg rating, $347/day. Quality challenges and top-rated options.

• Only 6 five-star facilities
• 60% have 2 stars or below
• Medi-Cal planning essential

Chicago Nursing Homes

83 facilities, 2.0 avg rating, $335/day. Critical quality concerns.

• 52% are 1-star facilities
• Only 11 facilities with 4+ stars
• Careful selection critical

Houston Nursing Homes

62 facilities, 3.0 avg rating, $195/day. Best value among major cities.

• 14 five-star facilities (23%)
• 36% below national median cost
• Better quality + lower costs

Phoenix Nursing Homes

24 facilities, 3.1 avg rating (highest), $250/day. Quality leader.

• 3.1 stars - highest average
• 42% have 4+ stars
• 18% below national cost

Philadelphia Nursing Homes

50 facilities, 2.6 avg rating, $437/day (highest cost). Financial planning essential.

• $159,505 annually
• 43% above national median
• PA Medicaid critical

San Diego Nursing Homes

21 facilities, 3.8 avg rating, $360/day. Exceptional quality with coastal lifestyle.

• 7 five-star facilities (33%)
• 67% have 4+ stars
• Year-round mild climate

Austin Nursing Homes

25 facilities, 2.7 avg rating, $213/day. Excellent affordability in Texas capital.

• 4 five-star facilities
• 30% below national median cost
• Save $33,000 annually

Oklahoma City Nursing Homes

28 facilities, 2.6 avg rating, $204/day. Best affordability among major cities.

• 7 facilities with 4+ stars
• 33% below national median
• Save $57,000 annually

Dallas Nursing Homes

35 facilities, 2.9 avg rating, $194/day. Major metro with small-town pricing.

• 12 facilities with 4+ stars (34%)
• 36% below national median
• UT Southwestern, Baylor healthcare

San Antonio Nursing Homes

60 facilities, 2.4 avg rating, $202/day. Maximum choice at minimum cost.

• 60 facilities - most of any major city
• 12 facilities with 4+ stars
• 34% below national median

Fort Worth Nursing Homes

30 facilities, 2.4 avg rating, $180/day. Dallas neighbor with Cowtown character.

• Only 5 facilities with 4+ stars (17%)
• 41% below national median
• Western heritage, family values

Jacksonville Nursing Homes

34 facilities, 3.7 avg rating, $318/day. Florida's quality leader - 62% have 4-5 stars!

• 11 five-star facilities (32%)
• 21 facilities with 4-5 stars (62%)
• Mayo Clinic, Baptist Health, UF Health

Columbus Nursing Homes

31 facilities, 2.6 avg rating, $315/day. Ohio capital requires careful selection.

• Only 7 facilities with 4-5 stars (23%)
• 52% are 2-star facilities
• 6 five-star options - tour them all

Indianapolis Nursing Homes

45 facilities, 2.6 avg rating, $279/day. Midwest value - 9% below national average.

• 10 facilities with 4-5 stars (22%)
• $279/day - save $9,490/year vs national
• IU Health, Ascension infrastructure

Charlotte Nursing Homes

21 facilities, 2.5 avg rating, $290/day. Limited market - consider suburbs.

• Only 4 facilities with 4-5 stars (19%)
• Smallest market among major metros
• Expand search to Concord, Matthews

Tampa Nursing Homes

18 facilities, 2.8 avg rating, $350/day. Small market - explore Tampa Bay area.

• Only 3 facilities with 4-5 stars (17%)
• 15% above national median cost
• Expand to St. Pete, Clearwater, Brandon

Nashville Nursing Homes

12 facilities, 2.9 avg rating, $300/day. Smallest market - ZERO five-star options!

• Only 3 four-star facilities (25%)
• No five-star facilities available
• Expand to Brentwood, Franklin, Murfreesboro

Denver Nursing Homes

23 facilities, 3.1 avg rating, $345/day. Quality leader - 39% have 4-5 stars!

• 4 five-star facilities (17%)
• 9 facilities with 4-5 stars total (39%)
• Mile High altitude consideration

Atlanta Nursing Homes

20 facilities, 2.5 avg rating, $311/day. CRITICAL: 40% are one-star facilities!

• 3 five-star facilities (15%)
• 8 one-star facilities (40%) - severe quality divide
• Tour ONLY the 6 facilities with 4-5 stars

Seattle Nursing Homes

20 facilities, 3.5 avg rating (HIGHEST!), $450/day. 60% have 4-5 stars!

• 4 five-star facilities (20%)
• 12 facilities with 4-5 stars (60%) - quality leader
• Premium pricing for exceptional care

Additional Resources

Nursing Home Tour Checklist

Essential questions to ask and what to observe during facility tours

More Guides Coming

We're continuously adding new data-driven guides to help families make informed decisions about senior care.

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