Guide
Nursing Home Evaluation Checklist
A weighted scoring rubric to objectively evaluate and compare nursing homes across data, observation, and financial viability.
TL;DR
Evaluate each nursing home across three phases: CMS Data Review (50 pts), In-Person Observation (30 pts), and Financial Viability (20 pts). Total score out of 100. Score every facility the same way to remove gut-feeling bias and make an objective comparison.
Why You Need a Scoring System
Choosing a nursing home based on gut feelings leads to inconsistent decisions. A facility with a beautiful lobby can have a terrible inspection history. A plain-looking building can deliver outstanding care. A standardized rubric forces you to weigh what actually matters — government data, observable care quality, and financial sustainability — instead of being swayed by aesthetics or a polished sales pitch.
This rubric is weighted toward CMS data (50%) because government inspection and staffing data is the most objective, comprehensive, and comparable information available. In-person observation (30%) adds context that data alone cannot capture. Financial viability (20%) ensures the facility is affordable and stable.
Phase 1: CMS Data Review (50 Points)
Start with data before you ever set foot in a facility. Search for the facility on CareGrader to review its grade, inspection history, staffing levels, quality measures, and penalty record. Score each category below.
Inspection Grade
15 pts- CareGrader grade A or B with no immediate jeopardy citations in the last 3 cycles: 13-15 pts
- Grade C with minor deficiencies only: 8-12 pts
- Grade D or F, or any immediate jeopardy or abuse citations: 0-7 pts
Staffing Score
15 pts- RN hours per resident per day above national average, turnover below 50%: 13-15 pts
- Near-average staffing with moderate turnover (50-65%): 8-12 pts
- Below-average staffing or turnover above 65%: 0-7 pts
Quality Measures
10 pts- Falls, infections, rehospitalizations, and antipsychotic use all below state average: 8-10 pts
- Mixed results, some metrics above average: 4-7 pts
- Multiple metrics significantly above state average: 0-3 pts
Penalty History
10 pts- No fines, payment denials, or SFF status in the last 3 years: 9-10 pts
- Minor fines only (under $20,000 total): 5-8 pts
- Significant fines, payment denials, or SFF/SFF candidate status: 0-4 pts
Phase 2: In-Person Observation (30 Points)
Data tells you a lot, but it cannot tell you everything. Visit the facility and score what you observe. For a detailed list of what to look for during your visit, see our visiting checklist guide.
Environment
10 pts- Cleanliness throughout (not just the lobby)
- No persistent odors (urine, feces, or heavy air freshener)
- Safety features: handrails, grab bars, non-slip flooring, clear exits
- Adequate lighting and accessible outdoor spaces
Staff & Residents
10 pts- Staff respond to call lights within 5 minutes
- Staff address residents by name, treat them with dignity
- Residents appear clean, groomed, and engaged
- Visible staffing level matches CareGrader data
Dining & Activities
5 pts- Food appears appetizing and is served at proper temperature
- Residents who need help eating receive patient assistance
- Posted activity calendar with varied programming
Administrator Transparency
5 pts- Willingly discusses recent inspection findings
- Provides specific staffing ratios and turnover data
- Welcomes unannounced future visits
Phase 3: Financial Viability (20 Points)
Quality care that you cannot afford or that may not survive financially is not a viable option. Use our cost calculator and paying for care guide to evaluate these factors.
Cost Alignment
10 pts- Monthly cost fits within your budget using available payment sources (Medicare, Medicaid, insurance, private pay)
- Facility accepts your payment method (especially Medicaid if relevant)
- No hidden fees or unexpected charges beyond the quoted rate
Financial Stability
10 pts- Occupancy rate above 80% (low occupancy can signal financial trouble)
- No recent ownership changes or bankruptcy filings
- Stable ownership with a track record across multiple facilities
Scoring Summary
Add up all three phases for a total score out of 100. Use the following thresholds to guide your decision:
| Score | Rating | Action |
|---|---|---|
| 85-100 | Strong candidate | Proceed with confidence; verify with a second visit |
| 70-84 | Viable | Acceptable, but investigate weak areas before deciding |
| 60-69 | Marginal | Consider only if options are very limited |
| <60 | Eliminate | Remove from consideration |
Use CareGrader's comparison tool to view facilities side by side as you score them.
Red Flags That Override Your Score
Certain findings should disqualify a facility regardless of its overall score. If you encounter any of these, eliminate the facility from consideration.
- !Special Focus Facility (SFF) status — CMS has identified this facility as one of the worst-performing in the country and subjected it to increased inspections.
- !Abuse or neglect citations — any substantiated finding of resident abuse or neglect in the last 3 inspection cycles.
- !Immediate jeopardy citations — the most severe deficiency category, meaning a situation that caused or was likely to cause serious injury or death.
- !Persistent understaffing — staffing consistently below CMS minimum thresholds with no improvement trend.
- !Administrator refuses to answer questions — evasiveness about inspection results, staffing, or finances is a serious warning sign.
- !Facility restricts unannounced visits — federal law gives residents the right to receive visitors. A facility that discourages unannounced visits may be hiding problems.
Start Your Evaluation
Begin Phase 1 by looking up facilities on CareGrader. Review their grades, inspection history, and staffing data to build your shortlist before scheduling visits.
Frequently Asked Questions
How many nursing homes should I evaluate with this rubric?
Score at least three facilities so you have a meaningful comparison. Start by using CareGrader to identify facilities with strong grades in your area, then apply this rubric to your top candidates. Scoring more facilities gives you a better baseline for what is typical in your region.
Can I skip Phase 1 and just visit in person?
Phase 1 (CMS Data Review) accounts for 50 points out of 100 because government data is the most objective and comprehensive source of quality information. Visiting without reviewing data first means you lack context for what you are seeing. A facility can look pleasant on a tour day but have a history of serious deficiencies, high staff turnover, or recent fines.
What score should I look for in a nursing home?
A score of 85 or above indicates a strong candidate worth serious consideration. Scores between 70 and 84 are viable but may have areas of concern that warrant follow-up questions. Scores between 60 and 69 are marginal and should only be considered if options are limited. Below 60, the facility has significant issues and should generally be eliminated.
How often should I re-evaluate a nursing home after placement?
Re-score the facility every quarter using updated CMS data on CareGrader. Nursing home quality can change quickly due to ownership changes, staffing shifts, or new inspection findings. If the score drops below 70, schedule an in-person visit to assess current conditions and consider whether a transfer is warranted.
What if every facility in my area scores below 70?
In areas with limited options, focus on which specific categories are weakest. A facility scoring low on financial viability but strong on inspections and staffing may be acceptable. A facility scoring low on inspections due to abuse or neglect citations is a different concern entirely. Also consider expanding your geographic search radius or exploring assisted living if the care level is appropriate.