How the Trust Index Works

The Trust Index is a composite score derived entirely from federal data published by the Centers for Medicare & Medicaid Services. No facility pays to appear on this site. No facility can improve its score through sponsorship, advertising, or a referral relationship with us. The Trust Index reflects one thing: what the federal record says about how a facility actually performs.

The Trust Index can reach a maximum of 80 points and draws from three domains. Staffing accounts for up to 40 of those points — the largest single factor — because the research is consistent: the amount of time registered nurses spend with residents is among the strongest predictors of patient safety and care outcomes. Inspection history contributes up to 25 points, drawing from the findings of actual on-site health surveys, the severity ratings assigned to deficiencies, and the record of complaint investigations. Patient outcomes — measures like hospital readmission rates and discharge-to-community rates — contribute up to 15 points.

The score is then adjusted downward for federal accountability events: penalty assessments, payment denials, and Special Focus Facility status. A facility with strong staffing and inspection scores but a history of significant federal fines will carry a lower Trust Index than those scores alone would suggest. This matters because financial penalties represent moments when CMS determined that harm occurred or conditions were serious enough to warrant formal sanction. That history belongs in the score.

The CMS five-star rating is the most widely used benchmark for nursing home quality, and it's a reasonable starting point. But it has structural limitations that matter clinically.

CMS stars aggregate three component ratings — health inspections, staffing, and quality measures — in a way that allows strong performance in one domain to offset serious deficiencies in another. A facility can achieve an overall rating of four or five stars while maintaining registered nurse hours well below what the clinical literature considers safe. CMS has set a minimum threshold of approximately 0.55 RN hours per resident per day, but many four- and five-star facilities hover just above that floor. At 0.4 or 0.5 RN hours per resident per day, a facility is operating with a level of licensed nursing coverage that most clinicians would consider inadequate for a medically complex population.

The Trust Index addresses this by weighting RN staffing heavily and treating it as a primary signal, not one input averaged against others. It also gives meaningful weight to penalty history. CMS stars do not adjust substantially for facilities that have been fined or cited for serious violations — a facility can accumulate federal penalties without seeing meaningful movement in its star rating. The Trust Index reflects that record directly.

Placet does not accept payment from facilities for placement, ranking, or inclusion. There are no sponsored listings, no featured placements, and no tiered visibility based on advertising spend. We do not receive referral fees from facilities when a patient is placed. We do not display third-party advertisements.

A facility's Trust Index score cannot be improved by contacting us, paying us, or establishing any kind of business relationship with us. The only way a facility's score improves is if the underlying federal data improves — meaning better staffing, cleaner inspection results, stronger outcomes, and fewer penalties.

All data underlying the Trust Index is drawn from the CMS Provider Data Catalog, which is updated on a quarterly basis. The specific datasets include staffing data from the Payroll-Based Journal reporting system, health inspection records including survey findings and deficiency severity ratings, quality measure performance across the 15 measures tracked by CMS, federal penalty records including fines and payment denials, and ownership records.

We do not supplement CMS data with user-submitted reviews, facility-provided information, or third-party ratings services. When CMS data is updated, scores are recalculated automatically.

We publish our full methodology because we believe the people using this tool — discharge planners, social workers, care coordinators, and the families they support — deserve to know exactly how a score was derived and why.

If you're a social worker presenting a facility recommendation to a patient family, you should be able to explain it in one sentence: this facility scored well because federal data shows strong nurse staffing, a clean inspection history, good patient outcomes, and no history of federal penalties. That's the sentence the Trust Index is designed to make possible.

The Trust Index is not a perfect instrument. Federal data has lags, gaps, and known limitations — and we document those on the methodology page. But it is built from the most reliable public record available on nursing home performance, weighted the way a clinician would weight it, and adjusted for the accountability events that matter most. That's the commitment behind this tool.