U.S. News and World Report’s nursing home ratings for 2026 expand metrics used for evaluation while also adding data from a greater variety of sources than in the past. Quality indicators nearly doubled, with emphasis placed on staffing across different roles – and the results show a correlation between staffing levels and top-rated facilities.

The best nursing homes on the list provide 20% more total staffing per resident per day compared to the national average, U.S. News found. And top performing short-stay facilities offer 80% more physical therapy per resident per day than the national average.

For long-term residents, top-rated nursing homes have a 15% lower rate of hospitalizations compared to the national average. Short-term residents or rehab patients at the highest-performing skilled nursing facilities have a 33% lower rate of emergency room visits compared to the national average.

Researchers expanded the number of quality metrics for the ratings from nine to 19 for short-term rehabilitation and from eight to 17 for long-term care, Ben Harder, managing editor and chief of health analysis at U.S. News, told Skilled Nursing News. Such refinements parallel adjustments made to the U.S. News’ Best Hospitals evaluation. U.S. News began publishing online ratings of nursing homes in 2009.

California had the highest number of best nursing homes by state at 295, followed by Florida at 196, Pennsylvania at 175, New York coming in at 157 and Ohio at 108.

New York City had the highest number of best nursing homes by U.S. metro at a whopping 183, before numbers drop off at 81 in Philadelphia and 68 in Chicago. Behind these metros were San Francisco-Oakland with 63 best nursing homes, then Miami-Fort Lauderdale with 60 and Boston with 58.

Staffing numbers tell a story

Instead of just having a single staffing quality metric, U.S. News tracked nurse staffing and physical therapist staffing for its short-term rehabilitation rating, along with overall staffing and coverage on weekends.

“We’re looking at the totality of nursing care across different different job functions … physical therapy also is a measure that we’re using,” said Harder. “That staffing level, in all of its nuance and complexity, is a large part of the methodology.”

The list doesn’t have a staffing threshold like the federal mandate did, but evidence is clear that at least to a point, more staffing is better, Harder said.

“It’s not realistic to staff at some idealized threshold for all nursing facilities, so we don’t have any magic number in our methodology that a nursing facility has to hit,” added Harder. “It is really looking at staffing as a continuous measure.”

Initially, U.S. News was aligned with CMS ratings, taking what was on Nursing Home Care Compare and republishing that information for a larger audience.

Methodology for the list evolved over time, making a “pretty significant break” from just the CMS data, thanks to input from industry professionals, Harder said. Other key updates to the methodology for the list include “domain overviews,” including staffing, process and outcomes. This allows residents and their families to check more specific measures of performance.

One such measure is antipsychotic use across the entire population of the nursing home, Harder said. U.S. News uses data provided by AARP rather than CMS for this measure.

“We chose to use that instead of the published CMS measure that’s conceptually analogous but essentially excludes a lot of patients because they’ve been assigned these diagnoses of psychosis, even though academics and industry professionals have raised real concerns about whether those diagnoses are actually accurate,” said Harder.

Value for residents, families and nursing home chains

Overall, U.S. News believes the list takes stock of which measures are reliable signals of quality in nursing homes.

The list also separates ratings by long-term and short-term care, so residents and their families can understand quality through both lenses.

“It almost seems like CMS was avoiding it … nursing facilities that are good at one may not be good at the other, and nursing facilities that provide one may actually not provide the other,” said Harder. “We want to make sure that whatever a family needs, there’s a rating that’s relevant to them.”

As for operators, Harder hopes the list serves as a jumping off point for conversations with health systems, and provides support when nursing home chains seek to prove their worth to partnering hospitals. Acute care systems can also look at top ranking skilled nursing facilities and choose to strengthen certain relationships, he said.