Grading Methodology

The Nursing Home Report Card utilizes staffing data compiled by the Kaiser Health Foundation, performance measures from the Center for Medicare and Medicaid Services’ Nursing Home Compare[1], and the Office of State Long-Term Care Ombudsman complaint data.

The following select measures were arranged by quintile distribution and assigned a letter grade based on each state’s (including the District of Columbia) comparative ranking:

Nursing Home Compare Data

  • State’s average professional nurse (licensed nurse and/or registered nurse) hours per resident per day
  • State’s average certified nurse assistant hours (CNA) hours per resident per day
  • Percentage of facilities with above average[2] professional nurse staffing
  • Percentage of facilities with above average direct care staffing
  • Percentage of facilities with above average health inspections
  • Percentage of facilities with deficiencies (Calendar Year 2013)
  • Percentage of facilities with severe deficiencies[3] (CY13)

Long-Term Care Ombudsman Data

  • Percentage of verified ombudsman complaints (Federal Fiscal Year 2012) [4]

The aforementioned measures were averaged, ranked and assigned a final letter grade based on each state’s relative ranking.

  • = states ranked 1-10
  • = states ranked 11-20
  • = states ranked 21-30
  • = states ranked 31-40
  • = states ranked 41 or worse

How It Works

A state’s “Final Grade” is calculated by averaging assigned grades (based on comparative rankings) using the following formula:

Sum of the Average Grades for: Professional Nurse Hours Per Resident Per Day, Certified Nursing Assistant Hours per Resident per Day, Percentage of Facilities with Above Average Professional Nurse Staffing, Percentage of Facilities with Above Average Direct Care Staffing, Percentage of Facilities with Above Average Health Inspections, Percentage of Facilities with Deficiencies, Percentage of Facilities with Severe Deficiencies, Percentage of Verified Ombudsman Complaints
8 (selected measures)

Using Kansas as an example, comparative quintile ranking and assigned grades would be:

AVERAGE RANKSTATE RANKGRADE
28.1330THC

based on the state’s compiled data:

MEASUREPRO. NURSE
HOURS
DIRECT CARE STAFF HOURSPRO. NURSE STAFF ABOVE AVGDIRECT CARE STAFF ABOVE AVGHEALTH INSPECT. ABOVE AVG% FACILITIES DEFICIENCIES% FACILITIES SEVERE DEFICIENCIES% VERIFIED OMBUDSMAN COMPLAINTS
COMPILED DATA1.832.5650.00%57.34%43.36%94.76%18.88%87.74%
STATE RANKING8th22nd37th37th16th30th42nd32nd
GRADEACDDBDCF

[1] The Government Accounting Office stressed that Nursing Home Compare data has some “limitations” as much of the data is self-reported by nursing homes (GAO-09-689, August 2009).

[2] Above average – nursing homes rated as 4-star or 5-star facilities by the Center for Medicare and Medicaid Services as of May 20, 2014

[3] Severe deficiencies – immediate jeopardy or actual harm violations that resulted in resident injury, abuse, neglect or death

[4] Verified complaints – a higher frequency of verified complaints indicates problems in nursing homes are more commonplace or widespread.  This measure reflects first-hand accounts from residents, families, staff and others about overall nursing home care.