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Understanding our predictive quality ratings
The SunsetWell Score is a 0-100 rating that predicts a nursing home's likelihood of adverse health events for residents. We provide two separate metrics:
Absolute healthcare quality measure
How this facility compares to peers in your state
What it measures: How good is this facility at preventing adverse health events?
Example: A facility with a score of 78 has "Very Good" healthcare quality, meaning it shows strong performance at preventing adverse events.
Key point: This score is NOT peer-normalized. A score of 78 means the same thing whether the facility is in California or Wyoming - it's an absolute measure of healthcare quality.
What it measures: How does this facility compare to other nursing homes you might be considering in the same state?
Example: 85th percentile in California means this facility ranks better than 85% of California nursing homes (top 15%).
The SunsetWell Score and Percentile Rank answer different questions:
SunsetWell Score answers:
"Is this facility good at preventing adverse health events?"
Percentile Rank answers:
"How does this facility compare to my other options in this state?"
Facility in San Francisco, CA
This is a good facility, but CA has many excellent options. You might find better nearby.
Facility in rural Wyoming
This is a good facility AND it's one of the best available in your area. Strong choice.
We analyze quality metrics from:
All data comes from publicly available federal sources.
We use machine learning to analyze data from all ~14,700 Medicare-certified nursing homes (100% coverage) to identify which factors ACTUALLY predict patient harm.
What we measure: Our model focuses on actual patient harm outcomes including falls with injury, pressure ulcers, UTIs, weight loss, improper antipsychotic use, and substantiated complaints—not just process metrics.
Unlike the CMS star formula, our v2.3 model is trained directly against a composite harm index (clinical harm measures, inspection severity, and federal penalties). It is designed to complement CMS stars, not replace them: stars summarize regulatory performance, while our score is a harm-weighted composite with finer granularity.
Our approach: We weight inspection severity, staffing depth and stability, clinical harm measures (MDS quality indicators), and facility-specific complaint/incident rates using weights learned from the harm index. Because complaint rates are one of the model's inputs, we treat complaint correlations as a sanity check rather than independent validation — fully external validation (predicting next-period outcomes) is on our public roadmap.
Official Federal Rating
CMS rates all nursing homes 1-5 stars based on health inspections, staffing levels, and quality measures using a simple formula.
When to use it:
Filter out unacceptable facilities (avoid 1-2 star facilities)
Predictive Harm Model (v2.3)
A 0-100 score built from harm-related measures (falls with injury, pressure ulcers, UTIs, antipsychotics, complaint citations, inspection severity). Built to surface harm signals that a simple star formula can average away, with 100 gradations instead of 5.
When to use it:
Compare facilities that pass your CMS threshold, with harm-focused weighting and peer-percentile context
No. CMS 5-star ratings are the only official federal ratings. Our score is analytical research based on publicly available CMS data.
CMS uses a simple formula (add/subtract stars) focused primarily on process metrics. We train our model directly on patient harm outcomes (falls with injury, pressure ulcers, infections, complaint citations), so the two can legitimately disagree: a facility can satisfy process requirements while showing elevated harm signals, or vice versa. When they disagree, we recommend reading both — and checking the inspection details we publish on each facility page.
We publish our validation numbers whether they flatter us or not. In our latest evaluation (June 2026), the SunsetWell Score correlates with size-adjusted substantiated-complaint rates at Spearman ρ = 0.41 — modestly below CMS Overall stars (0.46) and Health Inspection stars (0.48), and well above CMS Staffing (0.25) and Quality Measure stars (0.09). Because complaint data also feeds the model, we treat this as a sanity check, not proof of superiority. What the score adds over stars is granularity (0-100 vs 5 buckets), harm-focused weighting, and peer-percentile context. Full details are in our methodology documentation.
Our methodology is documented and reproducible: we publish the feature families, training approach, and validation statistics. The only way to durably improve a SunsetWell Score is to improve the underlying inspection results, staffing stability, and clinical outcomes — which is the point.
Both are valuable. Use CMS stars to set your minimum threshold, then use SunsetWell Score to compare among acceptable facilities. Think of it like buying a car: CMS is the safety rating (must pass), SunsetWell is the Consumer Reports ranking (which one is best).
We recalculate scores with each CMS data refresh. Our facility data was last refreshed in June 2026.
Our v2.3 model achieves complete nursing-home coverage through robust handling of missing data.
Assisted living scores are different: most states publish far less inspection and outcome data for assisted living than CMS does for nursing homes, so ALF scores are built primarily from state licensing and capacity data. We label them accordingly on facility pages, and they should not be read as equivalent to nursing-home harm-model scores.
Scores are recalculated with each CMS data refresh (data last refreshed June 2026).
Current score version: v2.3 "Predictive Harm" (launched October 2025)
Not a guarantee: No score can perfectly predict future outcomes. Healthcare quality depends on many factors, some of which can't be measured from available data.
Visit in person: Use our score as a starting point, but always visit facilities in person, talk to staff, and trust your instincts.
Individual needs vary: A high-scoring facility might not be the right fit for your specific situation. Consider your loved one's medical needs, location preferences, and family priorities.
SunsetWell Scores are analytical tools based on publicly available data and should not be considered medical advice. Always consult with healthcare professionals and visit facilities in person before making placement decisions. Past performance does not guarantee future results.
CMS 5-Star Ratings are the official federal quality ratings for nursing homes. For official quality information, visit Medicare.gov.
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