How We Evaluate Elder Care

TheCareRatings.com aggregates over 50 data points from 12 federal agencies to help families make one of the most consequential decisions of their lives. Unlike traditional senior care directories that rely on user reviews or paid placements, every metric on this platform is derived from publicly available government data — the same data used by hospitals, state health departments, and federal regulators.

This page documents exactly what we measure, where we get it, how often it is updated, and why we chose it.

The Zero Pay-to-Play Guarantee

Every senior care directory on the internet has a business model problem: they are paid by the facilities they are supposed to objectively evaluate. Sponsored listings, featured placements, and "preferred partner" badges are how most directories generate revenue. The result is a system where a facility with a history of federal penalties can appear at the top of search results because they paid for placement.

TheCareRatings.com is built on a different foundation. Our ratings are calculated algorithmically from federal inspection records, staffing payroll data, and enforcement actions. A facility cannot pay to hide a penalty, alter a star rating, or improve its position in our rankings. Our scoring formula is documented publicly on this page. Any journalist, researcher, or family member can verify our numbers against the original CMS source data at any time.

The Care Quality Index

The Care Quality Index is a proprietary composite score (0–100) that we calculate for every U.S. state and territory. It is designed to give families, journalists, and policymakers a single, comparable number that captures the overall quality of nursing home care in a given state — accounting for clinical outcomes, enforcement history, and staffing levels simultaneously.

How the Index Is Calculated

The index combines three metrics drawn from CMS federal data, each weighted to reflect its relative importance as a predictor of resident outcomes. The formula is:

The average CMS star rating (which ranges from 1 to 5) is normalized to a 0–100 scale using the formula ((avg_rating - 1) / 4) × 100 before weighting. The penalty-free and high-staffing components are already expressed as percentages (0–100) and are applied directly.

Why These Three Metrics?

Average CMS Star Rating is the most widely recognized federal quality indicator for nursing homes. CMS calculates this rating using a complex composite of health inspection results, staffing levels, and quality measures. It is updated quarterly and is the primary metric families use when comparing facilities on Medicare.gov. We weight it at 40% because it is the most comprehensive single indicator available.

Zero-Penalty Rate measures the percentage of facilities in a state that have received zero enforcement penalties from CMS in the past three years. Penalties are issued when inspectors find deficiencies that cause actual harm or immediate jeopardy to residents. A high zero-penalty rate indicates a state where facilities are generally operating within federal safety standards. We weight this at 35% because enforcement history is one of the strongest predictors of ongoing care quality and is extremely difficult for facilities to manipulate.

High-Staffing Rate measures the percentage of facilities in a state where the staffing rating is 4 stars or higher, based on CMS Payroll-Based Journal (PBJ) data — actual payroll records, not self-reported hours. Staffing levels are the single most important operational factor in nursing home quality; understaffed facilities have higher rates of pressure ulcers, falls, infections, and hospitalizations. We weight this at 25% because staffing data has more missing values than the other two metrics, which slightly reduces its statistical reliability at the state level.

Our Data Sources

The platform draws from eight distinct federal data categories. Each category is maintained by a separate U.S. government agency and updated on its own schedule. Below, we document every data point we collect, the exact agency and dataset it comes from, and how frequently it is refreshed. Each category below includes the full data point list.

Data Update Schedule

Our data pipeline ingests updates from federal agencies on a rolling schedule. The table below shows the update frequency for each data category and the typical lag between a federal agency's data release and its appearance on TheCareRatings.com.

What We Do Not Use

We are as transparent about our exclusions as we are about our inclusions. TheCareRatings.com does not use user-generated reviews or ratings of any kind. We believe that star ratings submitted by anonymous users — however well-intentioned — are susceptible to manipulation, selection bias, and emotional distortion. Families who have had a terrible experience are more likely to leave a review than families who had an ordinary one. This creates a systematically skewed dataset that cannot be corrected without access to the underlying population.

We do not use data from third-party aggregators or data brokers who repackage government data without clear provenance. Every data point on this platform can be traced directly to its original federal source. We do not accept data submissions from facilities, management companies, or their representatives.

We do not use social media signals, web traffic data, or any commercial data source that could create a financial conflict of interest between our ratings and the facilities we evaluate. Our revenue model is built around family-facing tools and facility-claimed listings — not on selling favorable placement in our rankings.

Our Open Data Commitment

All of the underlying data that powers TheCareRatings.com is in the public domain. It was collected by federal agencies using taxpayer funding and is freely available to any researcher, journalist, or developer who wants to access it directly. We believe this data belongs to the public, and our mission is to make it accessible and actionable for families who do not have the technical resources to download and analyze federal databases themselves.

We actively encourage journalists, researchers, and policy advocates to use our analysis as a starting point for their own investigations. If you are working on a story about nursing home quality, elder care policy, or healthcare access and would like access to our aggregated state or city-level datasets, please contact us at data@thecareratings.com. We will respond within 48 hours.

Citing TheCareRatings.com

If you are a journalist, researcher, or policy professional citing data or analysis from TheCareRatings.com, please use the following citation format:

TheCareRatings.com. "Care Quality Index: State-by-State Nursing Home Quality Rankings."
TheCareRatings.com, 2026. https://www.thecareratings.com/methodology

For questions about our data methodology, corrections, or media inquiries, contact: press@thecareratings.com