Key Findings
- •CMS tracks 100% of Medicare-certified nursing homes (14,751 facilities) with mandatory reporting requirements
- •7 major data categories cover everything from staffing levels to safety violations and resident outcomes
- •Updated quarterly - more current than most online review sites and facility marketing materials
- •Publicly accessible and completely free - no subscription or registration required
- •Standardized metrics allow true apples-to-apples comparisons between facilities nationwide
The Problem with Most Nursing Home Information
You're trying to find the best nursing home for your parent. You've toured several facilities, each with gleaming brochures promising "compassionate care" and "experienced staff." You've read online reviews - but there are only three reviews for one facility, and they wildly contradict each other. The facility director assures you they have "excellent staffing," but what does that actually mean?
This is the challenge every family faces: how do you cut through marketing language and subjective opinions to find objective facts about nursing home quality?
The answer is CMS data. The Centers for Medicare & Medicaid Services collects comprehensive, standardized data on every Medicare-certified nursing home in the United States. This isn't marketing material or selective testimonials - it's government-verified information that facilities are legally required to report. And it's completely free and publicly accessible.
In this guide, we'll explain what CMS data includes, why it's more reliable than other sources, and exactly how to use it to make an informed decision about nursing home care.
What Is CMS Data?
The Centers for Medicare & Medicaid Services (CMS) is the federal agency that administers Medicare and oversees Medicaid. To participate in these programs, nursing homes must meet strict quality standards and report detailed data about their operations, staffing, and resident outcomes.
✅ Why This Data Exists
CMS collects this data for oversight and accountability, but makes it publicly available so families can make informed decisions. Every Medicare or Medicaid certified nursing home must participate - they can't opt out or selectively report. This means you have access to the same information government inspectors use to evaluate facilities.
How CMS Collects Data
Health Inspections
State survey agencies conduct unannounced inspections annually, examining care quality, resident rights, safety, and sanitation.
Staffing Data
Facilities submit payroll-based journal (PBJ) data directly from their payroll systems, showing exactly how many hours each type of staff member worked.
Quality Measures
Facilities complete MDS (Minimum Data Set) assessments for each resident, tracking health status, functional ability, and clinical outcomes.
Complaints & Penalties
CMS tracks substantiated complaints, enforcement actions, and financial penalties in real-time as they occur.
The 7 Types of CMS Data Available to You
CMS organizes nursing home data into seven major categories. Understanding what each category tells you - and what it doesn't - is key to making informed comparisons.
1. Star Ratings (Overall Quality)
The most visible CMS metric is the 1-5 star rating system. Facilities receive an overall rating plus three component ratings: Health Inspections, Staffing, and Quality Measures.
What this tells you: A quick summary of overall quality across multiple dimensions. Great for initial screening.
What it doesn't tell you: Two facilities with the same overall rating can have very different strengths and weaknesses. Always look at component ratings.
2. Staffing Data (Nurse Hours & Turnover)
CMS tracks exactly how many hours of nursing care each resident receives per day, broken down by registered nurses (RNs), licensed practical nurses (LPNs), and nurse aides. They also track turnover rates.
What this tells you: Whether the facility has adequate staffing levels and retains experienced nurses.
What it doesn't tell you: Staff quality, training, or attitudes. High numbers don't guarantee compassionate care, but low numbers are a red flag.
3. Health Inspection Results (Deficiencies & Violations)
Every facility receives an annual unannounced inspection. Inspectors cite deficiencies on a scale from A (minimal harm potential) to L (immediate jeopardy). CMS publishes every deficiency citation.
- Quality of care (pressure ulcers, falls, medication errors)
- Resident rights (dignity, privacy, choice)
- Infection control
- Food service and nutrition
- Environmental safety
What this tells you: Specific problems found during inspections and how severe they were.
What it doesn't tell you: Issues that occurred between inspections or problems inspectors didn't observe during their visit.
4. Quality Measures (Resident Outcomes)
CMS tracks 17 clinical quality indicators measuring how well facilities help residents maintain or improve their health and functional status.
- Pressure ulcer prevalence
- Falls with major injury
- Urinary tract infections
- Ability to move independently
- Self-care abilities
- Bladder control
- Antipsychotic medication use
- Appropriate drug regimen
- Pain management
- Depression screening
- Vaccination rates
What this tells you: Actual resident outcomes - whether people are getting better, worse, or staying stable.
What it doesn't tell you: Some facilities serve sicker residents, which can affect outcomes. CMS adjusts for risk, but interpretation requires context.
5. Safety & Compliance (Critical Violations)
CMS specifically tracks serious safety issues including abuse/neglect allegations, fire safety violations, and emergency preparedness.
What this tells you: Whether the facility has a history of the most serious violations.
What it doesn't tell you: Issues that haven't been reported or investigated yet.
6. Complaints & Penalties (Enforcement Actions)
When families or staff file complaints, state agencies investigate. CMS tracks substantiated complaints and lists all enforcement actions including fines, payment denials, and required improvement plans.
- Civil monetary penalties: Fines ranging from hundreds to hundreds of thousands of dollars
- Denial of payment: Medicare/Medicaid won't pay for new admissions
- Temporary management: State takes over facility operations
- Termination: Facility loses Medicare/Medicaid certification (rare but serious)
What this tells you: How often the facility has serious enough problems to trigger government action.
What it doesn't tell you: Complaints that weren't substantiated or issues that families didn't report.
7. Facility Characteristics (Ownership & Services)
CMS also publishes basic information about each facility's ownership, size, and services offered.
- Ownership type (for-profit, non-profit, government)
- Number of certified beds and current occupancy
- Accepts Medicare, Medicaid, or both
- Special services (rehabilitation, dementia care, hospice)
- Continuing care retirement community (CCRC) status
What this tells you: Basic operational facts and whether the facility can meet your payment and care needs.
What it doesn't tell you: Quality of specialized services or actual expertise in specific conditions.
Why CMS Data Is More Reliable Than Other Sources
When researching nursing homes, you'll encounter information from many sources. Here's how CMS data compares:
| Information Source | Objectivity | Coverage | Standardized | Updated |
|---|---|---|---|---|
| CMS Data | ✅ Government verified | ✅ 100% of facilities | ✅ Same metrics for all | ✅ Quarterly |
| Facility Marketing | ❌ Biased | ❌ Self-selected info | ❌ No standards | ⚠️ When convenient |
| Online Reviews | ⚠️ Subjective | ❌ Limited sample | ❌ No standards | ⚠️ Sporadic |
| Facility Tours | ⚠️ Curated experience | ❌ What they show you | ❌ No standards | ✅ Current snapshot |
| Word of Mouth | ⚠️ Personal experience | ❌ Single facility | ❌ No standards | ⚠️ May be outdated |
💡 Key Insight
CMS data isn't perfect, but it's the only source that provides standardized, verified metrics across all facilities. Marketing materials are biased. Reviews are subjective and sparse. Tours show you what the facility wants you to see. CMS data shows you what government inspectors found when they looked.
Real-World Example: How CMS Data Reveals Quality Differences
Two facilities in your area both have 3-star overall ratings. They look similar on paper. But when you dig into the CMS data, you discover they have very different strengths and weaknesses:
| Metric | Facility A | Facility B |
|---|---|---|
| Overall Rating | ⭐⭐⭐ 3 Stars | ⭐⭐⭐ 3 Stars |
| Health Inspection Rating | ⭐⭐ 2 Stars | ⭐⭐⭐⭐⭐ 5 Stars |
| Staffing Rating | ⭐⭐⭐⭐⭐ 5 Stars | ⭐⭐ 2 Stars |
| Quality Measures Rating | ⭐⭐⭐ 3 Stars | ⭐⭐⭐ 3 Stars |
| RN Hours/Resident/Day | 0.85 hours | 0.48 hours |
| Recent Deficiencies | 12 citations | 3 citations |
| Abuse Violations | 1 substantiated | 0 |
Which Facility Is Better?
It depends on your priorities:
- If your parent needs intensive nursing care (complex medical needs, multiple medications, recent hospital discharge), Facility A's excellent staffing (5 stars, 0.85 RN hours) is crucial - but the recent abuse violation is a serious concern.
- If your parent is relatively stable and you prioritize safety and clean inspection history, Facility B's 5-star health inspection rating and zero abuse violations make it the safer choice - but the low staffing (0.48 RN hours) means nurses may be stretched thin.
✅ The Power of CMS Data
Without CMS data, both facilities look identical (3 stars). With CMS data, you can see exactly where each facility excels and where they fall short - and make the choice that's right for your specific situation. This is why our side-by-side comparison tool is so valuable.
How to Access and Use CMS Data
CMS data is publicly available, but knowing how to interpret and apply it makes all the difference. Here's what to do - and what to avoid:
DO: Start with Pre-Analyzed Data
Raw CMS data requires significant effort to download, clean, and analyze. WiseCareGuide has already done this work for all 14,751 facilities.
- Search by location and filter by star ratings, staffing levels, or specific quality measures
- View our composite quality score (0-100) that combines multiple CMS metrics
- See trends over time - is the facility improving or declining?
DO: Look at Trends, Not Just Snapshots
A facility that earned 2 stars two years ago but now has 4 stars shows improvement. A facility that dropped from 4 stars to 2 stars is declining. Direction of change matters as much as current rating.Recent violations are more concerning than violations from several years ago that have been corrected.
DO: Compare Facilities Using the Same Metrics
CMS data's greatest strength is standardization. Use it to make apples-to-apples comparisons:
- Compare RN staffing hours across 3-4 finalist facilities
- Check which facilities have zero abuse violations in the past 3 years
- Look at pressure ulcer rates for facilities serving similar resident populations
- Use our comparison tool to see metrics side-by-side
DON'T: Rely on a Single Data Point
A 5-star rating is great, but what if the facility has high nurse turnover? Excellent staffing numbers are good, but what if they have recent serious deficiencies? Look at the complete picture across all seven data categories. Our composite quality score helps by weighing multiple factors together.
DON'T: Ignore Context
Some facilities serve sicker, more complex residents, which can affect quality measure outcomes. Small facilities (fewer than 50 beds) may have more variable data. Rural facilities may struggle to recruit staff.Consider the facility's circumstances, not just the numbers.
DON'T: Use Outdated Data
CMS updates data quarterly, but that still means the information could be 3 months old. Always check:
- When was the last health inspection? (Should be within past 15 months)
- What quarter does the staffing data reflect?
- Has there been a change in ownership or management since the data was collected?
Understanding the Limitations of CMS Data
CMS data is the most reliable objective information available, but it's not complete. Here's what it doesn't tell you - and why that matters:
⚠️ What CMS Data Doesn't Capture
These important factors aren't in CMS data:
- Staff attitudes and culture: Are nurses compassionate? Do aides treat residents with dignity? CMS measures staffing hours, not empathy.
- Food quality and variety: Nutritional standards are inspected, but taste, presentation, and meal enjoyment aren't measured.
- Activities and social engagement: CMS tracks whether activities are offered, not whether they're meaningful or well-attended.
- Cleanliness and aesthetics: Inspectors check for health hazards, not whether hallways are cheerful or rooms feel homey.
- Specialized expertise: A facility may have strong overall ratings but lack specific experience with dementia, Parkinson's, or your parent's particular condition.
- Communication with families: How responsive is the staff to questions and concerns? CMS doesn't measure this.
⚠️ Data Timing Issues
- Inspections are annual: A lot can change in a year. New management, staff turnover, or improved practices won't show up until the next inspection.
- Staffing data can be "gamed": Some facilities have been caught inflating staffing levels during the 2-week reporting period. This is why we also look at nurse turnover rates.
- Quality measures reflect past care: The pressure ulcer rate from last quarter tells you about care 3-6 months ago, not what's happening today.
⚠️ Statistical Caveats
- Small facilities have higher variability: A facility with 40 beds will have more statistical noise than one with 200 beds. One bad incident has a bigger impact on percentages.
- Not all measures apply to all residents: Short-stay rehabilitation patients have different quality measures than long-stay residents. Make sure you're looking at relevant metrics.
- Star rating algorithms can obscure details: The complex formula can hide important information. Always look at component ratings and specific metrics, not just the overall star rating.
💡 The Bottom Line on Limitations
CMS data is essential but not sufficient. Use it to screen facilities and make informed comparisons, but complement it with in-person visits, conversations with staff, and - if possible - talking to current residents' families. Data gets you 70% of the way there; the other 30% comes from your own observations and instincts.
Combining CMS Data with Other Decision Factors
The most effective approach uses CMS data as a foundation, then layers in other information. Here's a proven step-by-step process:
The 5-Step Selection Process
Screen with CMS Data
Search facilities in your area and apply filters:
- Eliminate 1-2 star facilities (unless there are specific reasons to consider them)
- Filter out facilities with recent abuse violations or serious health deficiencies
- Look for RN staffing above 0.7 hours/resident/day
- Check that nurse turnover is below 50%
Compare Top Candidates
Use our side-by-side comparison tool to evaluate 3-4 finalists:
- Compare staffing levels, quality measures, and deficiency histories
- Look at trends - is each facility improving or declining?
- Note specific strengths that match your parent's needs (e.g., low fall rates if mobility is a concern)
- Check proximity to family members who will visit regularly
Visit in Person
Schedule tours, ideally at different times of day. During your visit, observe:
- How staff interact with residents - are they rushed, patient, respectful?
- Cleanliness and odors (some smell is normal; overwhelming odor is a red flag)
- Resident engagement - are people sitting alone or participating in activities?
- Staff responsiveness - do call lights get answered promptly?
- Meal quality and dining atmosphere
Ask Specific Questions
Based on what you learned from CMS data, ask targeted questions:
- "I see you had a staffing violation last year - what changes have you made?"
- "Your RN hours are lower than other facilities I'm considering. How do you ensure quality care?"
- "You have excellent quality measures. What do you do differently?"
- "How do you handle [specific condition your parent has]?"
- "Can I speak with the director of nursing? Meet the social worker?"
Trust Your Instincts
After reviewing data and visiting facilities, trust your gut feeling. If a facility has great numbers but something feels "off" during your visit, that matters. If a facility has okay numbers but the staff clearly cares and your parent feels comfortable there, that matters too. CMS data informs your decision - it doesn't make the decision for you.
Ready to Use CMS Data to Find the Right Facility?
WiseCareGuide has analyzed CMS data for all 14,751 Medicare-certified nursing homes, making it easy to search, compare, and make informed decisions. Start your search today with the most comprehensive, objective data available.
About Our Data
WiseCareGuide aggregates and analyzes data from the Centers for Medicare & Medicaid Services (CMS) covering all 14,751 Medicare-certified nursing homes in the United States, Puerto Rico, Guam, and U.S. Virgin Islands.
CMS Data Sources:
- Provider Information (Nursing Home Compare database)
- Health Inspection surveys (annual state surveys)
- Staffing data (Payroll-Based Journal - PBJ)
- Quality Measures (MDS 3.0 resident assessments and claims-based measures)
- Deficiencies, Complaints, and Penalties data
- COVID-19 vaccination and case data
- Ownership and facility characteristics
Our data is updated quarterly to reflect the latest CMS releases. Last updated: October 2024. All statistics and examples in this guide are based on actual CMS data analysis.
Related Resources
Understanding Star Ratings →
Deep dive into how CMS calculates the 1-5 star ratings and what they really mean
Search All Facilities →
Find nursing homes by location and filter by quality ratings
Compare Facilities →
Side-by-side comparison of staffing, quality measures, and violations
State Rankings →
See the top 25 facilities in each state based on comprehensive quality data