US States Ranked by Average CMS Nursing Home Overall Rating
PlainNursing ranks US states by the arithmetic mean of facility-level CMS five-star overall ratings, rendered server-side from the states table.
Research period:
Research question
Across the 53 CMS reporting jurisdictions, how does the average facility-level overall star rating vary, and which states' nursing-home portfolios cluster at the high and low ends of the CMS five-star distribution?
Methodology
This ranking reflects the data currently in our database, sourced from the agency referenced in the citation below and updated automatically as new filings are processed.
Coverage and exclusions: the source agency occasionally suppresses values for confidentiality, small sample size, or quality control, and suppressed rows are excluded from this ranking rather than shown as zero. If the agency later revises a figure, the revised value replaces the old one automatically the next time our data is refreshed.
Data provenance: we pull each release as it becomes available and normalize it into our database; a later release simply supersedes the one before it, so readers never see a mix of old and new figures on the same page.
Comparability across years: when the source agency revises its release schedule, definitions, or coverage, we note the affected years on the methodology page so readers can compare like-with-like rather than across a changed measurement.
Editorial governance: a named editor reviews every ranking page before publication (see the byline above). If an entity disputes a figure attributed to it, corrections are checked against the official source record before any change is made.
Every number on this page can be traced back to its source by following the entity links and the citation below, so independent verification never requires anything beyond the original public source.
See the methodology page for the complete ETL pipeline, source vintage, and column lineage.
US States Ranked by Average CMS Nursing Home Overall Rating
Live data: reflects the current dataset
The ranked top 10
Every row below reflects the current 10-record dataset. Reload the page after new data is processed to see the latest values.
| # | State | Avg overall (1-5) | SNFs |
|---|---|---|---|
| 1 | Hawaii | 3.56 | 42 |
| 2 | Alaska | 3.45 | 20 |
| 3 | Arizona | 3.42 | 140 |
| 4 | Arkansas | 3.37 | 221 |
| 5 | Utah | 3.34 | 97 |
| 6 | New Jersey | 3.3 | 348 |
| 7 | Delaware | 3.28 | 44 |
| 8 | Florida | 3.21 | 694 |
| 9 | Washington | 3.19 | 194 |
| 10 | Ohio | 3.18 | 922 |
Source: Centers for Medicare & Medicaid Services, Nursing Home Compare, Provider Information dataset with five-star overall ratings. Values reflect the current dataset, refreshed as new filings are processed. Centers for Medicare & Medicaid Services, Nursing Home Compare, Provider Information dataset with five-star overall ratings. Values reflect the current dataset, refreshed as new filings are processed.
Findings
Top entity in the ranking
The top-ranked record in this dataset is Hawaii, with a value of 3.56 on the Avg overall (1-5) column. The full top-10 set is rendered in the table above. Every value comes directly from the current dataset; no number is hardcoded into this page. When the Centers for Medicare & Medicaid Services publishes a revision, the ranking and the prose around it update automatically.
Distribution shape
The gap between the top-ranked record (3.56) and the 10th-ranked record (3.18) characterizes how concentrated the top of the distribution is. Where the top value is many multiples of the median value of the visible set, the population is highly concentrated, a small number of entities accumulate the bulk of the measured quantity. Where the top and bottom of the visible set are close together, the distribution is relatively flat across the top end. The full distribution beyond this top-10 cut is summarized in the aggregate context section below and explored in the linked entity profiles.
Aggregate context
Across the full population behind this ranking, here are the summary statistics: how many records exist in total, the sum of the ranking metric across all qualifying records, and the mean per-record value. The methodology page documents the exact filter applied (records with null or zero values on the ranking metric are excluded). This aggregate row is computed from the same dataset that powers the ranking above.
Source provenance
The records in this ranking originate from Centers for Medicare & Medicaid Services, specifically the Nursing Home Compare, Provider Information dataset with five-star overall ratings. PlainNursing ingests the source vintage published by the agency and keeps this page current, there is no static export carrying stale numbers, and a newly published dataset is reflected here within hours. The methodology page documents the source URL, the vintage date, and the steps applied to prepare the data.
Why this ranking matters
Rankings like this one let a reader scan a population quickly and identify outliers, concentrations, and patterns that warrant deeper investigation. The detail pages linked from each entity in the table above give the full per-entity context: time-series history where available, related metrics from adjacent tables, and links onward to the underlying source records. The methodology page explains how an entity earns inclusion in the dataset and how the ranking column is computed at the source.
What this analysis cannot tell us
Averages are unweighted means of facility-level CMS overall ratings within the state and treat each facility equally regardless of bed count or annual resident-day volume. We require a state to have at least 20 reporting facilities for inclusion to avoid distortion from small-territory denominators (e.g. US Virgin Islands, Guam-type jurisdictions). CMS overall ratings combine three sub-domains, health inspections, staffing levels, and quality measures, into a five-star score; the methodology and its weights are subject to periodic CMS revision and the rating reflects measured-performance bands not absolute clinical quality. State rankings can shift quarter to quarter as CMS refreshes the public dataset; this ranking reflects the dataset's most recent published version. Inter-state variation can be driven by enforcement practice, ownership-type mix (for-profit vs non-profit vs government), Medicaid reimbursement rates, and labor markets, not solely by care quality.
Secondary cut from the same source
10 states with the lowest average overall rating (20+ SNF facility floor)
Sources
- CMS Nursing Home Compare, Provider Information dataset - https://data.cms.gov/provider-data/dataset/4pq5-n9py
- CMS, Five-Star Quality Rating System technical documentation - https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/FSQRS