Washington, DC — The best-performing nursing homes are staffing up — and it shows. New 2026 ratings from U.S. News & World Report find that top-ranked facilities provide roughly 20% more total nursing hours per resident day than the national average, a gap closely tied to lower hospital readmissions and higher satisfaction scores.
The analysis, released Thursday, evaluated more than 15,000 Medicare- and Medicaid-certified nursing homes nationwide. Only 18.7% earned a “Best Nursing Home” designation across short-term rehabilitation and long-term care. Those top-rated facilities delivered an average of 4.2 total nursing hours per resident day (HPRD), compared with a national average of 3.5 HPRD.
In a news release, U.S. News leaders said the ratings are intended to give families clearer, comparable information on the measures that matter most. “These ratings empower families with transparent data on what truly matters — staffing that keeps loved ones safe,” said Editor-in-Chief Jake Barnes. “Top homes aren’t just compliant; they’re exceeding expectations by 20% in care hours.”
Staffing drives quality — and the score
U.S. News strengthened its methodology this year, placing greater emphasis on staffing and outcomes. Staffing now accounts for 40% of each facility’s overall score, up from 30% in the prior cycle, according to the publication. The ratings also incorporate new and expanded measures, including emergency department visits, 30-day readmissions, and resident and family feedback from CAHPS surveys.
The findings arrive as nursing homes work to meet the federal staffing rule finalized by the Centers for Medicare & Medicaid Services (CMS) in 2024. That rule phases in minimums that include a total of 3.48 HPRD, with specific RN and nursing assistant components and allowances for rural providers. According to industry data cited in the ratings, a large share of facilities are not yet in full alignment with those standards as they phase in, even as average RN hours nationally hover around 0.8 HPRD.
U.S. News’ analysis links stronger staffing to better results: top-rated homes reported about 15% lower readmissions and fewer falls and infections than typical facilities, based on the measures used. The ratings draw heavily on CMS payroll-based staffing data for 2024, aiming to reflect current workforce levels rather than pre-pandemic norms.
Operators flag cost and workforce hurdles
Providers say the numbers underscore a familiar challenge: recruiting and retaining enough staff to meet both resident needs and new federal benchmarks. Labor costs account for as much as 70% of operating expenses in skilled nursing, and turnover remains stubbornly high in many markets, according to industry reports. Facilities that reach “Best” status often cite investments in training and pay — steps associated with lower turnover — but not all operators can match those budgets, especially in rural and Medicaid-heavy regions.
“We have a shortage of qualified nursing home staff in every state,” CMS Administrator Chiquita Brooks-LaSure said in a September statement outlining new federal workforce investments. CMS recently announced more than $75 million to support nurse training and retention initiatives aimed at helping providers meet the rule’s requirements.
Industry groups generally applaud the spotlight on quality while warning that mandates without new funding could strain fragile operators. Leaders say more targeted support — from immigration pathways for caregivers to rate increases for Medicaid — will be needed to prevent access problems or closures in underserved areas.
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