Nursing home ratings are taken from the following three sources of data:

— Health Inspections: The nursing home health inspection process looked at all major aspects of care in a nursing home (about 180 different items). There were onsite visits by trained inspectors. Also, federal surveyors checked on the state surveyors’ work to make sure they followed the national process and that any differences between states stay within reasonable bounds.

— Staffing: The quality ratings look at the overall number of staff compared to the number of residents and how many of the staff are trained nurses.

The ratings considered differences in how sick the nursing home residents were in each nursing home, since that will make a difference in how many staff are needed.

Federal officials admit the staffing data was self-reported by the nursing homes, rather than collected and reported by an independent agency. Staffing data are reported just once a year and reflect staffing over a two-week period of time.

— Quality measures: The quality measures looked at how well each nursing home performed on ten important aspects of care. For example, how well the nursing home helped people keep their ability to dress and eat, or how well the nursing home prevented and treated skin ulcers.

The ten quality measures used were employed in all nursing homes. However, the federal officials noted the quality measures were self-reported by the nursing home, rather than collected and reported by an independent agency and that the quality measures represent only a few of the many aspects of care.

Also, the quality measures were not adjusted for any special characteristics that residents of a particular nursing home may have, compared to most other nursing homes.

More specialized nursing homes may look better or worse with respect to any particular quality measure, depending on how different the population is compared to the residents in most other nursing homes.