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Senior Living

Senior living encompasses a broad range of senior housing options, ranging from independent living communities for seniors who are still capable of living on their own to nursing homes for those in need of more extensive medical and personal care. Somewhere along this spectrum lies assisted living, which offers far more personal care (such as assistance with activities of daily living) than an independent living facility. However, assisted living facilities don't have the full scope of medical services available at a nursing home.

Choosing Between Nursing Homes and Other Senior Living Options

While there are several factors you will need to take into consideration in choosing a senior living facility, the driving force in this decision will generally be a senior's health and physical condition. Early on in this process, many seniors will be able to get by living independently at home or in an independent living facility, perhaps with the help of a home health aid or a devoted loved one. As their health worsens, this arrangement may become either unmanageable for loved ones. Assisted living facilities offer an array of personal care services and many are even starting to provide routine medical care that previously was only available in nursing homes. For residents requiring 24/7 around the clock care or more advanced medical care, a nursing home will almost certainly be the only option.

Skilled Nursing Versus Traditional Nursing Homes

There are essentially two types of nursing homes: skilled nursing facilities and traditional nursing homes where residents permanently reside. Many nursing homes offer both skilled nursing and long-term care. For instance, many seniors will be transferred from a hospital to a skilled nursing facility for rehabilitation after an injury or major surgery. Once their rehabilitation is complete, if they are too weak or sick to return home, they might then be transferred to a long-term care unit in the same facility. Some nursing homes also offer special care units for residents with medical conditions requiring specialized care such as memory care units for residents with Alzheimer's or other forms of dementia.

Evaluating Nursing Homes

Short-Term Care

In assessing nursing homes, we look at a variety of categories. In the example above, a senior requiring rehabilitation might want to focus mostly on a nursing home's short-term care grade which evaluates datapoints most critical to this type of care. For instance, in this category we look at the nursing home's physical therapy and registered nurse staffing levels, as well as qualitative measures such as the percentage of residents who are able to return to their home. Some of the top skilled nursing facilities employ full time physical, occupational and respiratory therapists and offer residents more than an hour per day of registered nursing care. Typically, we look for facilities that enable the majority of their rehabilitation residents to return home. We find our short-term care category to be critical for evaluating skilled nursing facilities.

Long-Term Care

On the other hand, seniors in need of a permanent residence don't necessarily require the more advanced medical care and therapy offered by a skilled nursing facility. Many long-term care facilities operate more like traditional convalescent homes, offering robust personal care for residents who primarily require assistance with activities of daily living. Our long-term care grade focuses more on the sheer volume of staffing from nurse's aids and other attendants as opposed to focusing on the availability of more highly skilled medical professionals. We also focus on qualitative measures, such as the percentage of residents requiring hospitalization. We also look at the number of residents who received critical vaccines for deadly viruses such as influenza and pneumonia. Ideally, we like to see facilities vaccinating 100% of their patients given the risk that respiratory viruses pose for older people.


Our nursing category focuses on all levels of nursing care, ranging from nurse's aids to licensed or registered nurses. Many of the best nursing homes overall provide residents with more than four hours of nursing care per day. In this category, we also look at several quality measures such as the percentage of residents suffering from pressure ulcers or falls which resulted in injury. These ladder datapoints are accepted by many in the nursing home industry as qualitative measures of nursing care as many falls and pressure ulcers are the result of substandard care. For instance, while less than 5% of the residents at many elite nursing homes suffer from pressure ulcers, we found that figure to be 20% or higher for some of the lower rated facilities.


Arguably the most important category is inspections. In this category, we look at the data collected by government inspectors. Specifically, we break down the deficiencies found on those inspection reports, placing special emphasis on category G through L deficiencies. These are the deficiencies that endangered resident safety, with category J through L deficiencies possibly even risking their residents' lives. Any of these severe deficiencies warrants taking a closer look. Lastly, we also take substantiated resident complaints and government fines into consideration in this category. Government fines often suggest that a particular deficiency has persisted through multiple rounds of government inspections.

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