Turning Data into Action for Better Nursing Home Quality

People in the United States are living longer, and our population is also aging rapidly which provides a shared opportunity to expand options for in-home assistance and quality nursing home care that advances What Matters to all of us as we age.  

West Health’s Aging Readiness Dashboard measures how prepared each state is to meet the demographic shift by integrating national and state-level data across domains including:  demographics, economic security, health care coverage and access, health status, healthcare costs, mental health, nursing homes, caregiving, dementia, housing and homelessness, and transportation.  

CMS defines long-term services and supports as services and supports that help people of all ages with functional limitations or chronic illnesses live or work in the setting of their choice, whether at home, in the community, or in a nursing facility. Most Medicaid LTSS users now receive care at home or in the community; in 2021, only about one in six received institutional care, mostly in nursing homes. For older adults, that share is closer to one in three. And if someone turning 65 today has nearly a 70% chance of needing long-term care services and supports. This growing need will drive increasing demands on the nation’s long-term care system, primarily funded by Medicaid. Nursing homes are one of its foundational components, with nearly 15,000 nursing homes providing care to an estimated 1.2 million people. As Jeanette Sullivan-Martinez, Moving Forward Coalition Steering Committee member and President of Connecticut’s Resident Council Executive Board, notes: 

“A nursing home is a place where people live, not a place where people go to die.” 

Yet in many places nursing home quality is a concern The dashboard’s Nursing Home Domain  reveals that nearly three in five states' nursing homes average 3.1 stars or below on CMS’s Five-Star Quality Rating System, which reflects a composite of health inspections, staffing, and quality measures. This finding reinforces longstanding concerns about the quality of care provided to the people who live in nursing homes and indicates that there are many opportunities to integrate What Matters to residents into care and support models. Furthermore, this baseline predates the cuts to Medicaid, which are authorized by the 2025 Reconciliation law, and will reduce federal Medicaid spending, the backbone of long-term care financing, by $911 billion over the next decade. 

Nearly three out of five states’ nursing homes average 3.1 stars or below, a baseline that predates the Medicaid cuts.

Nursing home care is a mandatory Medicaid benefit, and Medicaid funds care for more than six in ten nursing home residents while also supporting essential home and community-based services (HCBS) for millions more. States cannot eliminate nursing home care even as budgets tighten due to the Reconciliation law and demand rises with longer lifespans and more complex care needs. That combination puts quality of care at risk, and the dashboard can help track changes in nursing home quality and older adults’ quality of life as these cuts take effect. 

Data gives us a powerful foundation to build on and provides a blueprint for where to direct resources to support aging readiness and improve long-term care quality across communities. The Moving Forward Coalition will use this data to advance What Matters to the people who live, work, and depend on nursing homes, because every nursing home should be a place where lives are nurtured, residents are empowered, and where people want to work.  

The Moving Forward Nursing Home Quality Coalition is a national initiative dedicated to improving care, dignity, and quality of life for people who live, work, and depend on nursing homes. Learn more at MovingForwardCoalition.org.