Nursing Home Glossary

Definitions for CMS nursing home data terms used on CareQED, including star ratings, staffing metrics, inspection deficiencies, and certification types.

Survey: An on-site inspection conducted by state survey agencies on behalf of CMS to assess a facility's compliance with federal quality and safety requirements. Surveys are typically unannounced and occur approximately every 12-15 months.
Deficiency (F-tag): A regulatory violation found during a survey. Each deficiency is assigned an F-tag (F followed by 3 digits) that corresponds to a specific federal requirement. The scope and severity of each deficiency is also rated.
Severe Deficiency: A deficiency with scope/severity codes G, H, I, J, K, or L, indicating actual harm or immediate jeopardy to residents. CareQED flags these as 'severe' and allows filtering to exclude facilities with recent severe citations.
Severity Code: A single letter (A through L) assigned to each deficiency that indicates both the level of harm and the scope of the violation (the letter shown in the Scope & Severity table above).
HPRD (Hours Per Resident Day): A staffing metric calculated as total nursing staff hours divided by total resident days. Higher HPRD generally indicates more staff time available per resident. CMS recommends at least 4.1 total nursing HPRD (this is guidance, not a strict requirement).
RN HPRD: Registered Nurse Hours Per Resident Day. The hours of care provided specifically by registered nurses, divided by total resident days. Higher RN HPRD indicates more skilled nursing coverage.
Total Nurse HPRD: The combined hours of all nursing staff (RNs, LPNs, and CNAs) per resident per day. This broader measure reflects overall staffing levels at the facility.
Medicare-Certified: A facility that has been certified by CMS to participate in the Medicare program and can receive Medicare reimbursement for covered services provided to eligible beneficiaries. Certification means the facility is eligible to bill the program; it does not guarantee availability or admission.
Medicaid-Certified: A facility that has been certified to participate in the state Medicaid program and can receive Medicaid reimbursement for covered services. Most nursing homes are dually certified for both Medicare and Medicaid. Certification means the facility is eligible to bill the program; it does not guarantee availability or admission.
Certified Beds: The number of beds at the facility that are certified for Medicare and/or Medicaid reimbursement. This reflects the facility's licensed capacity for certified residents.
Estimated Occupancy: An estimated occupancy percentage calculated by dividing the average number of residents per day by the total number of certified beds. This is an approximation based on CMS data and does not indicate current bed availability. Actual occupancy varies daily due to admissions, discharges, and other factors. Contact the facility directly for admission information.
Special Focus Facility (SFF): A nursing home that CMS has identified for additional oversight and more frequent inspections due to a history of serious quality issues. Facilities are selected based on their record of deficiencies, particularly those involving harm or immediate jeopardy to residents. Being designated as an SFF means the facility has demonstrated persistent problems and is subject to closer scrutiny by regulators. The status may show 'SFF' (currently on the list), 'SFF Candidate' (at risk of designation), or indicate the facility has graduated from the program.
Hospital-Based Facility: A nursing home that is physically located within or directly connected to a hospital. These facilities often specialize in post-acute care, providing skilled nursing services to patients transitioning from hospital stays. Hospital-based nursing homes may have closer access to physicians and acute care services.
Continuing Care Retirement Community (CCRC): A retirement community that offers multiple levels of care on one campus, typically including independent living, assisted living, and skilled nursing care. Residents can transition between levels of care as their needs change without having to move to a new location. CCRCs often require entrance fees and monthly payments.
Abuse Concern Flag: A warning indicator applied by CMS when a facility has received citations related to abuse, neglect, or exploitation of residents. This flag signals that inspectors found evidence of mistreatment during surveys. The presence of this flag warrants careful consideration and further research before choosing this facility.
Recent Ownership Change: Indicates the facility has changed ownership within the past 12 months. New ownership may bring different management practices, staffing policies, and quality priorities. Historical quality metrics may reflect the previous owner's performance rather than current management. Consider this when evaluating the facility's track record.
Resident and Family Council: Organized groups that give residents and their families a formal voice in facility operations. A Resident Council is run by and for residents to discuss concerns and advocate for improvements. A Family Council allows family members to meet regularly, share experiences, and communicate with management. Facilities with active councils often have better communication and responsiveness to resident needs.
Chain Affiliation: Indicates the facility is part of a larger organization that owns or operates multiple nursing homes. Chain-affiliated facilities may share standardized policies, training programs, and resources. The chain's average rating provides context for how this facility compares to its sister facilities. Large chains may have more resources but potentially less local flexibility.
Ownership Type: The legal structure of the facility's ownership, such as For-profit Corporation, Non-profit Corporation, or Government-owned. Different ownership types may have different operational priorities.
Source Publish Date: The date when CMS last updated the source dataset. This indicates when the underlying data was refreshed by CMS, not necessarily when individual facility data changed.
Ingested Date: The date when CareQED last fetched and processed data from CMS. This may differ from the source publish date if there was a delay in our data refresh cycle.