New York, New York — America’s best-performing nursing homes have something in common, and it isn’t fancy amenities. They send far fewer residents to the emergency room, and they staff at levels the rest of the industry hasn’t matched.
U.S. News & World Report released its 2027 Best Nursing Homes ratings Tuesday, evaluating more than 14,600 skilled nursing facilities across the country. Just 18% earned the “Best Nursing Home” designation. The top performers posted 21% fewer hospital readmissions than other facilities and offered 19% more total staffing per resident per day than the national average.
The staffing gap shows up where it matters most. Short-term rehabilitation patients at top-rated facilities experienced 19% fewer emergency room visits compared to the national average, and those homes provided twice as much physical therapy per resident day.
“These measures are working together to improve the quality of care,” Jordan Derk, senior care researcher at U.S. News, said of the findings.
A Rare Bit of Good News on Staffing
Buried in the report is what Derk called one of its most surprising findings: direct care nursing minutes rose from 26.5 to 27 per resident per day. That’s a small shift, but in a sector where chronic understaffing has dominated headlines for years, any movement counts. Staff retention ticked up too, from 53% to 54%.
“While that’s a small increase, it’s encouraging since that is such a big issue across the industry,” Derk said.
Not everything moved in the right direction. Hospital readmissions and acute care hospitalization rates rose nationwide, even as top performers stayed well ahead of the pack. And the report flagged a new concern: depressive symptoms among long-term care residents jumped sharply, from 10% to 13% compared with last year’s data.
Where the Best Homes Are
U.S. News scored facilities separately for short-term rehabilitation and long-term care, using 17 measures for each population. About 43 metropolitan areas stood out with 10 or more Best Nursing Homes, including Los Angeles, New York City and Chicago. Smaller markets held their own as well — Allentown, Pennsylvania; Buffalo, New York; and Oxnard, California all produced strong clusters of top-rated facilities.
By state, California led with 293 top-ranking facilities, followed by Florida with 191 and Pennsylvania with 170.
The ratings carry weight beyond family decision-making. Quality scores increasingly shape which homes win managed care contracts — and which get left out. Recent research has found that Medicare Advantage patients are far less likely to receive care at top-rated facilities, a gap operators can’t afford to ignore as the ratings bar keeps rising.
U.S. News kept its methodology unchanged this year after a significant overhaul in 2026, meaning families and operators can compare the two reports directly — and watch whether that staffing uptick becomes a trend or a blip.
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