Fewer than 20% of evaluated nursing homes made the list of “Best Nursing Homes” in U.S. News & World Report’s 2025 Best Nursing Homes rankings, out of nearly 15,000 facilities in the country. This includes those providing short-term rehabilitation, long-term care, or both.

And, nearly half of nursing homes didn’t comply with federal regulation to provide at least eight registered nurse staffing hours every day of the year, U.S. News found in its rankings released on Tuesday. The average nursing home had 15 days of inadequate staffing.

Staffing levels overall continue to be a major challenge for nursing homes across the country, said Ben Harder, chief of health analysis and managing editor at U.S. News.

The best short-term rehabilitation facilities had an average of 50% more total nursing care per resident than facilities rated as below average, Harder said in a statement. High ranking short-term rehab facilities also saw an average of 50% more resident discharges compared to those rated below average.

“That’s a pretty big difference since that is a key goal of providing rehabilitation for these patients. And these best nursing homes provide 50% more success than the worst nursing homes,” Harder noted.

For long-term care, those considered the best had double the staff retention rate of nursing homes when compared to underperforming long-term care facilities, he said.

Retention was a new measure this year when calculating ratings, defined as a percent of staff who remained after one year.

“The 2025 Best Nursing Homes ratings from the U.S. News & World Report recognize fewer than 3,000 top-performing nursing homes in the United States,” Zach Adams, senior health data engineer at U.S. News, told Skilled Nursing News. “U.S. News is committed to providing families with the data they need to make informed decisions about their loved ones’ care.”

Adams added that the ratings reveal significant disparity in multiple facets of nursing home care, referring to performance gaps when it comes to successful discharge rates, antipsychotic prescription rates, and nurse staffing numbers.

“U.S. News’ latest study on American nursing homes emphasize the importance of choosing a nursing home with a proven track record of quality care,” he added.

Another new measure for this year’s ratings was health deficiencies, determined by state inspectors who assess whether a facility has met the required standards of nursing home care, according to U.S. News.

More frequent, broader scope, and more severe deficiencies indicate an environment that may be detrimental to the safety of residents, U.S. News said.

The top long-term care facilities preserved residents’ self-reliance longer, ratings showed, including the ability to feed and wash themselves, compared to long-term care communities considered below-average.

“Which nursing home your loved one is residing in is potentially going to have a big impact on whether they maintain their ability to take care of themselves or whether they lose that ability,” Harder said. “That was a really important finding.”

High performing long-term care operators gave residents antipsychotic medications 46% less of the time, as opposed to poor-performing long-term care operators, U.S. News found.

“If they don’t need it for psychosis or some other mental condition, they really shouldn’t be receiving antipsychotic medications,” Harder said. “It is associated with higher fall risk and higher risks of other complications for those residents. We found that the best nursing homes are considerably less likely to be using those medications in these long-term care residents.”

Another long-term care finding of note: residents at high-performing facilities were more than 60% less likely to require emergency department care compared to those rated below average.

U.S. News ratings were calculated using a variety of quality measures obtained from the Centers for Medicare & Medicaid Services (CMS). Proprietary ratings methodology factors in resident care, safety, consistency and retention, along with the use of antipsychotic drugs and success in preventing emergency room visits, U.S. News said.

The greatest number of best nursing homes, according to rankings, were in the following ten metropolitan areas: Boston, MA; Chicago, IL; Miami-Fort Lauderdale, FL; Minneapolis-St. Paul, MN; New York, NY; Philadelphia, PA; Phoenix, AZ; San Diego, CA; San Francisco-Oakland, CA; and Washington, DC.