NH with Top Quality Ratings

Nationally, about 1 in 5 nursing home residents (22 percent) live in a facility with a 5-star rating, the highest quality rating possible as designated on CMS Care Compare star ratings. Inequities exist with respect to access to these facilities. When considering each state’s lowest performing group, Hawaii, Alaska, Delaware, Montana, and Maine stand out with at least 1 in 3 residents in those groups living in a 5-star facility. Across both statewide figures and figures specific to each state’s lowest performing group, fewer than half of residents in every state live in a top-rated facility.

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†† Due to small sample size of one or more racial/ethnic groups, this indicator could not be calculated.  An imputed value was used for scoring, but is not displayed or ranked.


The percent of nursing home residents in each state living in a nursing home that received a 5-star rating in its most recent survey as of the first Thursday of April 2021.

These data were averaged at the state level following the LTSS State Scorecard approach to measuring equity.

Equity adjustment: Race/ethnicity is indicated in MDS by a six-category multiple response variable with choices:

  • American Indian or Alaska Native
  • Asian
  • Black or African American
  • Hispanic or Latino
  • Native Hawaiian or Other Pacific Islander
  • White 

Residents were classified by race/ethnicity as follows:

  • Hispanic/Latino: “Hispanic or Latino” is selected
  • All Other Races/Ethnicities: exactly one race/ethnicity is selected (a resident is classified as “Asian” if and only if “Asian” is selected and no other races/ethnicity is selected)
  • Multiracial: “Hispanic or Latino” is not selected and two or more other races/ethnicities are selected

Data are presented for all residents and for each race/ethnicity group with sufficient sample size to report.  Residents without any race/ethnicity category selected are included in all residents but not in any subgroup.

For the equity adjusted metric score, residents are divided into two groups: White, and an aggregate grouping of {American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latino, Native Hawaiian or Other Pacific Islander, and Multiracial}.  The lower performing group (lowest percentage of residents living in a 5-star facility) is scored and ranked as a performance metric.

In New Hampshire and Vermont, the sample size was not sufficient to score both groups.  The metric value is therefore shown as N/A and the state is not ranked.  The metric value for all nursing home residents is used for calculating dimension-level performance.

Analysis of 2021 MDS 3.0 state-level care data provided by the Changing Long-Term Care in America Project at Brown University in February-April 2023.

Brown University (2023). Changing Long Term Care in America Project at Brown University funded in part by the National Institute on Aging (1P01AG027296). Providence, RI: Brown University School of Public Health,


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