Methodology · Federal oversight
Medicare- and Medicaid-certified Skilled Nursing Facilities report to the federal Centers for Medicare & Medicaid Services. This is the most comprehensive public data set available for any care setting — but it has real limits that families and researchers should understand.
Every SNF receives a standard health survey at least once every 15 months. Inspectors check for compliance with federal requirements across dozens of care categories — infection control, pressure ulcer prevention, medication management, resident rights, and more. Each violation is recorded as a deficiency citation with a severity and scope classification. CMS publishes the full list of citations, the dates of surveys, and whether cited deficiencies were corrected. We use this data in our inspection pillar and flagging system.
Since 2016, certified SNFs have been required to submit actual payroll data to CMS every quarter via the Payroll-Based Journal system. This gives CMS (and the public) actual staffing hours by employee type — Registered Nurse, Licensed Practical Nurse, Certified Nursing Aide — rather than self-reported estimates. CMS converts this to a “hours per resident per day” metric. We display RN hours separately because RN staffing is the most strongly predictive of care quality in the research literature.
CMS requires SNFs to disclose their ownership structure, including any management companies, real estate investment trusts (REITs), and related parties. The Affiliated Entity data published via Care Compare and our ownership pipeline lets us connect facilities to their parent operators and trace chain relationships. This is foundational to our private equity tracker and operator accountability features.
CMS can fine SNFs for serious or repeated deficiencies. Penalty records include the amount, the violation category, and whether the penalty was paid or reduced on appeal. We surface recent penalty history and flag facilities that have accumulated significant fines.
CMS collects standardized clinical assessments (MDS) on every resident and publishes facility-level outcome rates: hospitalizations, pressure ulcers, pain management, antipsychotic use, and others. These are rolled into the CMS 5-star Quality Measure rating. We display these measures individually and contextualize them against state and national benchmarks.
Complaints filed against SNFs — by residents, families, or staff — are investigated by state survey agencies under CMS contract. Substantiated complaint findings are included in the facility’s inspection record and contribute to the overall deficiency picture.
CMS designates the roughly 400 SNFs with the most persistent, serious quality problems as Special Focus Facilities. These facilities are inspected twice as often as standard SNFs and face escalating enforcement if problems are not corrected, up to and including Medicare/Medicaid termination. We flag SFF and SFF Candidate status prominently on facility profiles.
Federal oversight is powerful but narrow. Families are often surprised by what the public data set cannot tell them.
We sync with CMS Provider Data on a regular cadence and apply our own aggregation on top of raw federal records. Our Trust Index and four-pillar quality bar are derived entirely from CMS data — we do not introduce proprietary scoring on top of it. Where CMS has revised its methodology (e.g., the staffing star domain), we update our calculations to stay aligned.
We contextualize federal data with state and national benchmarks rather than presenting it in isolation. A 3.5 RN hours/day figure means different things in rural Pennsylvania versus urban California.