The Heart Of The Issue

Nursing Home Report Cards is a Families for Better Care tool that analyzes, compares and ranks state’s nursing home quality.

Families for Better Care is a non-profit citizen advocacy group dedicated to creating public awareness of the conditions in our nation’s nursing homes, assisted living facilities, and home and community based settings and developing effective solutions for improving quality of life and care.

Publication of our third Nursing Home Report Card is a revisiting of nursing home quality in all 50 states and in the District of Columbia.

Our team evaluated, scored, and graded each state using inspection, staffing, and advocacy data we obtained from the Center for Medicare and Medicaid Services and the Administration for Community Living. This is our third report card over the past six years and the first since 2014.

Our Report Card’s primary goal is to motivate states with poor grades to do a better job caring for nursing home residents while, at the same time, acknowledging the successful records of states with better grades.

A lesson we’ve learned through this evaluation process is, that no matter how good a state performs, there’s always an opportunity for more quality improvement. What sets apart the superior nursing home states from those with languishing scores is each state’s individual commitment to high staffing levels. The better the staffing scores, the better the overall grades. It’s that simple.

That’s why we’re renewing our call for lawmakers in each state that scored a “below average” grade in our 2019 Nursing Home Report Card to promptly enact, at minimum, the 4.1 hours of nursing time per resident daily as proposed by the National Consumer Voice for Quality Long-Term Care.

Unleashing new brigades of well-trained caregivers across the nursing home landscape will do much in securing a better nursing home for our loved ones and for those working in facilities.

Families for Better Care acknowledges that nursing homes cannot afford another unfunded mandate to improve quality. Providers are going to need our support, legislatively and financially, if they’re ever going to achieve the staffing standards needed to make facilities truly safe for our loved ones.

So for the first time, we’re asking federal and state policy makers, nursing home representatives, and everyone else interested in making nursing homes better, to prioritize new nursing home funding that will be used exclusively to shore up depleted staffing levels.

Accomplishing a better staffing standard and finding the legislative means to pay for it will dramatically improve care across the nation.

We stand ready to help.



Brian Lee, Executive Director
Families for Better Care



Families for Better Care recognizes the outstanding past contributions of the following whose insight and guidance helped bring the Nursing Home Report Card to fruition. We are very grateful for the support.

Richard Mollot, Ph.D.
Executive Director, Long-Term Care Community Coalition

Richard Mollot is the executive director of the Long-Term Care Community Coalition, a nonprofit organization dedicated to improving care for seniors, the disabled and other long-term care consumers through advocacy, education and policy research.

Richard has served on a number of state and national consumer, government and advisory groups relating to such issues as: geriatric mental health, long-term care restructuring, palliative care, nursing home “pay for performance” and quality improvement organizations. He is a graduate of Howard University School of Law and a member of the Maryland Bar.

Margaret Niederer, Ph.D.
Nursing Home Resident Advocate and Retired Illinois Regional Ombudsman

Margaret Niederer was a regional long-term care ombudsman for the Illinois Long Term Care Ombudsman Program for 12 years after her retirement from the Illinois State Board of Education.

Over a million dollars of grants were awarded to the regional program to assure the independence of the state program and to promote the recruitment of volunteer ombudsmen. This resulted in two Illinois laws passed in 2003, to assure the independence of the program, and to create the Illinois Long Term Care Council. She continues to advocate for older peoples’ rights and lives in Springfield, Illinois with her husband.

Long-Term Care Ombudsmen
Editor’s note: As a former ombudsman, I can say unequivocally that I have a special appreciation and a deep affection for the work of our nation’s ombudsman corp. The inclusion of their work in this report card, I believe, validates and honors their hard work on behalf of residents.

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