Best Nursing Homes list links top performers with better staff retention, efforts to lessen medication overload

A new report that lists what it calls the best nursing homes in the US finds that top-rated facilities continuously excel when it comes to adequate staffing levels, lower rehospitalization rates and less reliance on antipsychotic medications.

“Staffing is strongly linked to both quality of care and outcomes that nursing homes achieve,” Ben Harder, managing editor and chief of health analysis at U.S. News & World Report, told McKnight Long-Term News. “Best Nursing Homes for long-term care have significantly higher staff retention rates — double, in fact — when compared to below-average nursing homes. [And] Best Nursing Homes [honorees] for short-term rehabilitation have 50% more total nursing care per resident than those rated below average.”

U.S. News & World Report’s 2025 Best Nursing Homes ratings evaluated 14,832 nursing homes and found 19% to be high-performing. Some 1,327 performed high in long-term care, 2,152 were high-performing in short-term rehabilitation and 643 excelled in both.

California had the most LTC communities evaluated in the study (992), as well as the most high-performing (227). On the other end, West Virginia and Wyoming had just one LTC facility listed as high-performing, with seven and two being evaluated, respectively.

To curate the list, Harder said data is pulled from the Centers for Medicare & Medicaid Services Provider Info file to determine eligible nursing homes. Then, a series of quality measures is considered — a different approach than CMS would take and one that requires more in-depth research, he said.

“While much of our data comes from the same sources and time period as the measures CMS uses in its 5-Star system, our methodology … places more emphasis on patient and resident outcomes, such as which nursing homes succeeded in keeping their residents healthy and out of the hospital,” he said. “U.S. News places more emphasis on best practices, such as minimizing the use of powerful drugs that act as so-called ‘chemical straightjackets’ and come with serious risk of side effects for elderly patients.”

In fact, the report found that the best LTC facilities were 46% less likely to give residents antipsychotic medications compared to facilities rated as below average. 

With recent pushes to address medication overload, which has been linked to adverse drug effects in seniors who take a myriad of prescriptions, this could be a driver for some providers to follow suit with deprescribing. 

The biggest takeaway for providers, Harder said, is understanding what factors hold the most weight when attracting potential residents, their families and possible stakeholders. 

“The facts speak volumes: The facilities we’ve deemed Best Nursing Homes outperform other nursing homes by wide margins on quality, measure after measure. A facility that has earned the U.S. News designation sends a strong signal to patients and families, not to mention payers and other healthcare stakeholders, that it has better staffing, better care practices and better outcomes than its competitors,” Harder said. 

The report began circulating in 2009 to “offer individuals and families a starting point in their search for a nursing home, whether they are in need of short-term rehabilitation, long-term care or are interested in a home’s overall care,” according to U.S. News & World Report’s website.