U.S. News named more than 2,600 of the roughly 14,600 nursing homes it evaluated to its 2027 Best list on Tuesday, and its top performers ran 19% more staffing per resident and twice the physical therapy of the national average. The same day, an HHS Office of Inspector General audit found that Indiana’s county-hospital owners kept $479.8 million of the state’s nursing home supplemental payments, leaving the homes $205.2 million short. Rehinged scoring finds 1,434 low-rated, thinly staffed, high-turnover facilities on the wrong side of the U.S. News gap.
Why it matters for vendors: Staffing is now the clearest public line between top-rated and struggling buildings. 1,434 facilities hold one or two stars, report under 3.5 nursing hours per resident day and turn over half or more of their nursing staff. Workforce, retention and scheduling vendors should start in Texas, Missouri, Ohio and Illinois. In Indiana, where 113 nursing homes are licensed to local governments, vendors should sell through the management companies that run them, led by American Senior Communities, Trilogy and CarDon.
Quality & RatingsStaffing
U.S. News Names More Than 2,600 Best Nursing Homes for 2027 as Staffing and Therapy Separate the Top Tier
What happened
U.S. News & World Report released its 2027 Best Nursing Homes ratings on Tuesday. It evaluated more than 14,600 facilities and named about 18%, more than 2,600, as Best Nursing Homes, slightly fewer than in 2026. Facilities are rated on 17 measures in separate short-term rehabilitation and long-term care tracks, and the methodology did not change from last year. Top performers provided 19% more total staffing per resident per day than the national average and twice as much physical therapy, and their short-stay patients had 19% fewer emergency room visits and 21% fewer readmissions. Nationally, U.S. News reported a small rise in direct-care nursing time and an increase in staff retention from 53% to 54%, while depressive symptoms among long-stay residents climbed from 10% to 13%. Ensign Group said more than 100 of its affiliated facilities made the list.
Why it matters
The ratings shape the choices of hospital discharge planners, Medicare Advantage networks and families, and the measures that separate the winners are ones vendors can move: staffing levels, retention, therapy intensity and avoidable hospital transfers. Two findings point to new demand. Acute-care hospitalizations and short-stay readmissions rose nationally, which strengthens the case for care-transition and clinical monitoring tools. The jump in long-stay depressive symptoms gives behavioral health and resident engagement providers a fresh, quantified opening. Because the methodology held steady, operators can now track their own year-over-year movement and will look for products tied to a specific measure.
Rehinged Intelligence analysis of 14,686 scored facilities shows the same split on CMS data. The 3,154 five-star facilities average 4.40 total nurse staffing hours per resident day, against 3.52 at the 2,753 one-star facilities, a gap of 25%. Physical therapist time nearly doubles between the two groups, from 0.052 to 0.101 hours per resident day, and total nursing turnover falls from 54.1% to 37.7%. The U.S. News pattern is visible in every rating tier, not just at the top.
1,434
low-rated facilities with thin staffing and 50%+ turnover
9.8%
of all scored SNFs fall in that group
1,927
one- and two-star facilities with therapy need of 70+
Total nurse staffing hours per resident day
One- and two-star facilities under 3.5 nursing hours with 50%+ turnover, by state
The sharpest group is 1,434 facilities that hold one or two overall stars, report fewer than 3.5 total nurse staffing hours per resident day, and turn over 50% or more of their nursing staff. They average 1.4 stars, 3.13 nursing hours and 62% turnover across 116 beds, about 166,000 beds in total. Texas holds 291 of them, and Missouri’s 122 average just 2.83 nursing hours. A second, overlapping group matters to rehab providers: 1,927 one- and two-star facilities score 70 or higher on therapy services need. Vendors selling recruiting, retention and scheduling tools should prioritize Texas, Missouri, Ohio and Illinois, and contract therapy providers should work the 1,927 low-rated buildings where therapy need is highest.
Watch for: Whether operators cite the 2027 designation in Medicare Advantage network talks and hospital preferred-provider lists, and whether the rise in long-stay depressive symptoms shows up in CMS quality measures over the next refreshes.
ReimbursementRegulatory
OIG Finds Indiana County-Hospital Owners Kept $479.8 Million of Nursing Home Supplemental Payments
What happened
The HHS Office of Inspector General audited Indiana’s Medicaid nursing facility supplemental payments, choosing the state because it received the most in the country in fiscal 2022, about $1.02 billion of the $2.36 billion reported nationwide. Nonstate government-owned entities, mostly county hospitals that hold nursing home licenses, recovered $479.8 million of those payments, including $274.6 million they had originally put up as the state share. OIG concluded that nursing homes were shorted $205.2 million that was meant to raise their Medicaid reimbursement. The audit also found unreported overpayments, an extra leap-year day in the calculations and an incorrect federal matching rate. OIG recommended that Indiana refund $12.2 million to the federal government and look for ways to raise the share of supplemental payments that facilities keep.
Why it matters
Indiana’s model, in which county hospitals acquire nursing home licenses and contract with private managers to run them, has drawn scrutiny since a 2019 Senate Finance Committee report and a 2020 Indianapolis Star investigation. OIG noted that these payments often lack provider-level detail. If the state or CMS acts on the recommendation, more of the money would stay with the buildings, which means more spending capacity at the facility level. The audit also lands as federal oversight of Medicaid financing tightens, so other states that rely on public-owner arrangements could face similar reviews.
Rehinged Intelligence analysis finds 507 scored SNFs in Indiana with 48,825 beds. They run leaner than the nation on both occupancy and staffing: 75.9% of beds filled against 80.6% nationally, and 3.73 total nurse staffing hours per resident day against 3.90. 250 of them, about half, hold one or two CMS staffing stars. Of the 507, 113 are listed with government ownership in CMS records, about 11,458 beds or 23% of the state’s capacity.
113
government-owned SNFs in Indiana
49
of those hold one or two staffing stars
948
government-owned SNFs nationwide
Government-owned SNFs, by state
Purchasing in Indiana’s public-owned homes runs through private managers. American Senior Communities runs 29 of the 113, Trilogy Health Services 15 and CarDon & Associates 11, so three companies cover 55 of the 113 buildings. 49 of the 113 carry one or two staffing stars, so if more supplemental money stays in the buildings, staffing is the most likely first use. Indiana is not a distressed market by cost-report measures: 151 of 501 reporting facilities (30%) show a net loss, against 46.7% nationally. Vendors selling into Indiana should target the management company rather than the county license holder, starting with American Senior Communities, Trilogy and CarDon, and should watch Texas, whose 244 government-owned facilities are the largest public-owner footprint in the country.
Watch for: Indiana’s response to OIG’s recommendations, whether CMS turns the findings into Medicaid financing guidance, and whether OIG extends similar reviews to other states with large public-owner footprints such as Texas.