How to Choose a Nursing Home Using CMS Data

Q: How many nursing homes should we visit before deciding?

Ideally, visit at least three facilities that meet your baseline criteria, and visit each one more than once — including an unscheduled visit at a different time of day or a weekend. The experience during an unannounced visit, when staff are not prepared to show their best face, is often more revealing than a scheduled tour. Pay attention to staffing levels, resident engagement, and odors during each visit.

Q: What does "immediate jeopardy" mean in a deficiency report?

Immediate jeopardy (IJ) is the most serious category of nursing home deficiency. It means that a facility's action or inaction has caused or is likely to cause serious injury, harm, impairment, or death to a resident. Even a single IJ citation is a significant red flag. Facilities with repeat IJ citations — or IJ citations that persisted over multiple surveys — should be approached with extreme caution. Look up deficiency severity on each facility's page on PlainNursing.

Q: What is a Special Focus Facility (SFF)?

CMS designates certain nursing homes as Special Focus Facilities — facilities with a pattern of serious or repeated deficiencies that place them at the bottom of the national distribution for health inspection performance. SFF facilities receive more frequent surveys (approximately every 6 months instead of 12) and are subject to enhanced enforcement. Being on the SFF list is a serious warning sign. CMS also maintains a "SFF candidate" list of facilities that qualify but have not yet been designated.

Q: What does ownership type tell me about a facility?

Nursing homes can be for-profit, non-profit, or government-owned. Research consistently finds that for-profit facilities — especially those owned by private equity firms or large chains — have lower staffing levels and more deficiencies on average than non-profit or government facilities. This does not mean every for-profit facility is poor quality or every non-profit is excellent, but ownership type is a useful signal when other data is ambiguous. CMS reports ownership type for every facility.

Q: Should I look at financial penalties in the facility record?

Yes. Civil monetary penalties (fines) are assessed when CMS or state agencies find that deficiencies are serious enough to warrant enforcement beyond a simple citation. The amount and frequency of fines over the past three years gives you a sense of whether a facility has systemic problems or isolated incidents. A large fine after a one-time serious event is different from a facility that accrues small fines repeatedly. PlainNursing displays penalty history on each facility page.

Q: How can I involve the current resident (or future resident) in the decision?

If the person moving in is able to participate, involve them at every step. Bring them on visits when health allows. Ask about their priorities — some people care most about private rooms, others about activities, others about food or proximity to family. CMS requires that residents have the right to participate in their own care planning and to voice grievances without fear of retaliation. Understanding a facility's culture around resident voice — do staff listen, does the facility have an active resident council — matters as much as the data.

A practical framework for evaluating facilities for a family member — combining government data with in-person visits to make a more informed decision.

Step 1 — Build a Shortlist with CMS Data

Start by identifying nursing homes within a practical geography — typically within 30–60 minutes of family, to make regular visits feasible. Research consistently shows that residents with frequent family visitors receive better care, so proximity matters. Once you have a geographic pool, use PlainNursing and CMS Care Compare to filter by:

Overall star rating: Use 3 stars or above as a starting filter, but do not stop there. Some 3-star facilities outperform 4-star ones in specific areas that matter most for your situation.
Staffing level: Look for facilities with RN hours per resident day at or above the state median. Very low RN hours (< 0.4 HPRD) are a hard red flag regardless of overall rating. See our staffing guide for benchmarks.
Certification type: Verify the facility is Medicare and Medicaid certified if you anticipate needing either benefit. Facilities that accept only private pay are not surveyed under the same CMS standards.
Beds and specialization: Some facilities specialize in memory care, ventilator-dependent residents, or short-term rehabilitation. Match the facility's capabilities to the resident's needs.

A Practical Shortlist Example

Say you live near Philadelphia and need a facility for a parent within 30 minutes. Your filters: 3+ stars, Medicare-certified, RN hours above 0.5 per resident day. Out of 45 facilities in the Philadelphia metro, 12 meet all three criteria. Of those 12, three have deficiency-free last inspections. Those three become your visit shortlist.

Data-Driven Shortlist

Using PlainNursing filters, a family narrowed 45 Philadelphia facilities to 3 candidates in under 10 minutes. The data eliminated facilities with RN hours below 0.5 HPRD, recent immediate jeopardy citations, or staffing star ratings below 2. See our staffing levels guide for HPRD benchmarks.

You can search and filter facilities by state on our state pages or use PlainNursing Search to find specific facilities by name.

Step 2 — Read Deficiency Reports Carefully

Deficiency reports from health inspections are public records, available through CMS Care Compare. Every deficiency citation includes a description of what the surveyor found, the regulatory standard that was violated, and the scope and severity code. Learning to read these reports is one of the most valuable research skills a family can develop.

The Scope and Severity Grid

Deficiencies are classified on a two-axis grid. Scope runs from isolated (one resident or one instance) to pattern (more than one resident or instance) to widespread (pervasive). Severity runs from potential for minimal harm → actual harm → immediate jeopardy. The combination gives each citation a letter code (A through L), with A being the least serious and L being the most serious — an immediate jeopardy situation affecting many residents.

D and below (A–D): Minimal harm or potential harm. Common across many facilities. A few D-level citations per year are expected and not alarming on their own.
E–G (actual harm, isolated to pattern): Requires closer examination. These citations mean a real resident was harmed. Read the description to understand what happened.
H–L (immediate jeopardy): The most serious category. Even a single IJ citation warrants serious concern. Facilities with multiple IJ citations over the three-year reporting window should be deprioritized or removed from your shortlist.

Look for patterns in the types of deficiencies. Repeated citations in the same category — say, repeated pressure ulcer deficiencies or repeated medication error citations — suggest a systemic problem rather than an isolated incident. A facility can dispute citations through an Informal Dispute Resolution process, so look at confirmed citations.

Step 3 — Check Penalties and Enforcement History

CMS and state agencies can impose civil monetary penalties (fines), denial of payment for new Medicare and Medicaid admissions, or in extreme cases, termination from the Medicare and Medicaid programs. PlainNursing displays the penalty history for every facility, including the date, type, and dollar amount of each fine.

Interpret penalties in context:

A single modest fine several years ago, with no subsequent citations, may reflect a resolved issue.
Multiple fines in recent years — especially escalating amounts — suggest ongoing systemic problems.
Denial of payment is a serious sanction. It means CMS determined the facility should not receive Medicare or Medicaid payments for new admissions until conditions improve.
Termination from Medicare or Medicaid means the facility lost its certification and could no longer serve beneficiaries. Even if reinstated, this history warrants significant scrutiny.

Reading Penalty Amounts in Context

Penalty amounts range from $1,000 for minor deficiencies to over $100,000 for repeated serious violations. CMS imposes per-instance and per-day fines: a $5,000 per-day fine sustained for 30 days becomes $150,000. A single $50,000 fine from 2021 with no subsequent citations is less concerning than $10,000 in fines every six months for two years running. Always read the deficiency guide alongside penalty data for full context.

You can browse national rankings of facilities by penalty amounts and deficiency rates on our rankings pages.

Step 4 — Visit in Person and Ask Specific Questions

No dataset replaces what you observe in person. Plan at least two visits to any facility you are seriously considering: one scheduled tour and one unannounced visit at a different time of day (early morning or after dinner on a weekend reveals a lot about everyday staffing). During visits:

Observe whether staff greet residents by name and engage warmly.
Check common areas: are residents sitting alone, or are there activities and interaction?
Note odors — persistent unpleasant odors in resident rooms or hallways can signal incontinence care lapses.
Ask to see a recent copy of the posted daily staffing schedule.
Request a meeting with the Director of Nursing and the Social Worker, not just the admissions coordinator.

Questions to Ask During Visits

What is the typical RN-to-resident ratio on the evening and night shifts?
How is care plan communication handled when the care team changes?
What is your staff turnover rate for CNAs over the past year?
How do you handle a resident who wants to raise a concern or complaint?
Is there an active resident council, and can I attend a meeting?
What is your policy for notifying family when a resident's condition changes?
How many residents in this unit have memory care needs, and what training do staff receive?

Step 5 — Understand the Admission Agreement

Before signing any admission agreement, review it carefully with an elder law attorney if possible. Key provisions to examine include: arbitration clauses (which waive your right to sue in court), discharge policies (under what conditions can the facility transfer or discharge the resident), and financial responsibility terms. Federal regulations prohibit facilities from requiring residents to sign arbitration agreements as a condition of admission, but some facilities include these as standard. You have the right to strike them.

Also review the rate structure: understand which services are included in the basic daily rate and which are billed separately (specialized therapies, certain medications, incontinence supplies, transportation). Cost surprises after admission are a common source of family conflict.

Key Contract Provisions to Review

Provision	What to Look For	Red Flag
Arbitration clause	Must be voluntary, not required for admission	Mandatory arbitration as condition of admission
Discharge policy	Specific grounds and 30-day written notice required	Vague or overly broad discharge criteria
Rate increases	30-day notice, documented justification	Unlimited or uncapped annual increases
Personal items	Inventory list, liability coverage	Facility disclaims all responsibility

For additional context on what quality data to prioritize, read our guides on understanding star ratings and what staffing levels mean.

Frequently Asked Questions

How many nursing homes should we visit before deciding?

Ideally, visit at least three facilities that meet your baseline criteria, and visit each one more than once — including an unscheduled visit at a different time of day or a weekend. The experience during an unannounced visit, when staff are not prepared to show their best face, is often more revealing than a scheduled tour. Pay attention to staffing levels, resident engagement, and odors during each visit.

What does "immediate jeopardy" mean in a deficiency report?

Immediate jeopardy (IJ) is the most serious category of nursing home deficiency. It means that a facility's action or inaction has caused or is likely to cause serious injury, harm, impairment, or death to a resident. Even a single IJ citation is a significant red flag. Facilities with repeat IJ citations — or IJ citations that persisted over multiple surveys — should be approached with extreme caution. Look up deficiency severity on each facility's page on PlainNursing.

What is a Special Focus Facility (SFF)?

CMS designates certain nursing homes as Special Focus Facilities — facilities with a pattern of serious or repeated deficiencies that place them at the bottom of the national distribution for health inspection performance. SFF facilities receive more frequent surveys (approximately every 6 months instead of 12) and are subject to enhanced enforcement. Being on the SFF list is a serious warning sign. CMS also maintains a "SFF candidate" list of facilities that qualify but have not yet been designated.

What does ownership type tell me about a facility?

Nursing homes can be for-profit, non-profit, or government-owned. Research consistently finds that for-profit facilities — especially those owned by private equity firms or large chains — have lower staffing levels and more deficiencies on average than non-profit or government facilities. This does not mean every for-profit facility is poor quality or every non-profit is excellent, but ownership type is a useful signal when other data is ambiguous. CMS reports ownership type for every facility.

Should I look at financial penalties in the facility record?

Yes. Civil monetary penalties (fines) are assessed when CMS or state agencies find that deficiencies are serious enough to warrant enforcement beyond a simple citation. The amount and frequency of fines over the past three years gives you a sense of whether a facility has systemic problems or isolated incidents. A large fine after a one-time serious event is different from a facility that accrues small fines repeatedly. PlainNursing displays penalty history on each facility page.

How can I involve the current resident (or future resident) in the decision?

If the person moving in is able to participate, involve them at every step. Bring them on visits when health allows. Ask about their priorities — some people care most about private rooms, others about activities, others about food or proximity to family. CMS requires that residents have the right to participate in their own care planning and to voice grievances without fear of retaliation. Understanding a facility's culture around resident voice — do staff listen, does the facility have an active resident council — matters as much as the data.

Sources

Centers for Medicare & Medicaid Services — CMS Nursing Home Compare
CMS — Five-Star Quality Rating System deficiency scope and severity guidelines
Long-Term Care Ombudsman Program — resident rights resources (acl.gov)
Medicare.gov — Nursing Home Compare consumer guide

This content is for informational purposes only and does not constitute medical advice. Nursing home selection is a complex decision that should involve the resident, family members, and qualified healthcare and legal professionals. Always consult a qualified healthcare professional before making care placement decisions.