Original research on CMS senior-care data

Two in five nursing homes are staffed at CMS's bottom two tiers, and staffing is the second-weakest of the four domains that build the overall star rating.

How many nursing homes carry the CMS abuse icon, how unevenly it falls across states, and why its absence tells you far less than its presence.

Comparison advice assumes facilities to compare. How often that holds: the share of counties with exactly one certified nursing home, and where they cluster.

CMS's top rating is far more common in some states than others. This measures the spread — and why it is not a state quality ranking.

The national distribution of CMS overall stars, how far it diverges from the inspection domain that drives it, and how often the abuse icon appears.

CMS reports six service lines per certified agency, far from universal. Which are scarcest, and where a plan requiring one has fewest options.

Whether a home health agency carries a CMS star depends heavily on its state. This measures coverage state by state, and where the public record runs thinnest.

How CMS quality-of-patient-care stars are distributed across Medicare-certified home health agencies — and how many agencies CMS cannot rate at all.

Ownership concentration measured across 300+ county nursing-home markets — and whether having fewer operators tracks with CMS quality ratings.

Medicare-certified home health is overwhelmingly for-profit. Ownership barely changes the CMS star score — but it changes whether CMS rates an agency at all.

Most grouped facilities cross state lines. Because CMS grades inspections on a within-state curve, one chain-wide average star blends care with geography.

How many operators run the nation's nursing homes, how concentrated the sector is, and what share of facilities belong to large chains.

The two CMS five-star systems are not the same. What each measures, how coverage differs, and why their stars cannot be compared one-for-one.

How common federal enforcement actually is: the share of nursing homes with fines, payment denials, high-severity citations, and the CMS abuse icon.