One of the most important and emotional decisions a person can make is how to care for their aging family members. That’s why, for the last six years, Newsweek has provided reliable guidance for readers to make informed choices for finding the right nursing home to transition elderly loved ones.
America’s Best Nursing Homes, in partnership with Statista, is Newsweek’s longest-running ranking.
The 2026 ranking measures the top 1,200 individual nursing homes, not large chains, in over 30 states across the country. Nursing homes on this ranking are categorized by state and size – including small, medium and large facilities based on the number of beds.
In addition to listing the top nursing homes, the ranking also includes whether Medicaid or Medicare is accepted and whether the facility has a resident or family councils, or both.
Unsurprisingly, California, Florida and New York, states with some of the highest populations in the U.S., are the most represented on the 2026 list.
In the latest ranking, here are the top 10 states with the most nursing homes:
- California – 122
- Florida – 107
- New York – 93
- Pennsylvania – 85
- Ohio – 74
- Texas – 74
- New Jersey – 65
- Illinois – 53
- Indiana – 52
- Michigan – 46
When broken down by size, these are the top five states in each category:
Facilities with 50-99 beds: Florida (48), Texas (40), Pennsylvania (28), California (25), Michigan (17)
Facilities with 100-149 beds: California (52), Ohio (46), Indiana (22), Pennsylvania (17), Wisconsin (15)
Facilities with over 150 beds: New York (74), New Jersey (50), Florida (45), California (45), Pennsylvania (40), Illinois (28)
The ranking is determined by four main categories: performance, reputation, accreditation and resident satisfaction.
“Excellence is defined above all by measurable quality: sufficient and stable staffing with low turnover, reliable weekend coverage, strong clinical outcomes and positive inspection results,” Statista told Newsweek. “Reputation among professionals, external accreditations, and the satisfaction of residents and their families also play a role. While in the past the focus often lay on basic care and comfort, the definition has shifted toward transparency, data-driven evaluation and verifiable quality indicators.”
Performance score is comprised of staffing, quality measures and health inspections. Staffing includes hours, weekend hours and staff and administrative turnover. Quality metrics include long-stay and short-stay data like percentages of hospitalizations, vaccinations, falls, residents who need help with daily activities and catheter insertions and pressure ulcers. Finally, annual health inspections are collected and weighted based on the extent and severity of deficiencies. These inspections vary by state.
The reputation score is derived from a nationwide survey of medical professionals, including nurses, administrators and physicians. Participants recommend nursing homes based on quality of medical care, nurse staffing, quality of services like dining and leisure activities and accommodations and amenities.
The accreditation score reflects the range of structural and/or quality requirements from the Joint Commission and the Commission on Accreditation of Rehabilitation Facilities.
Finally, the resident satisfaction score is based on Google reviews. Facilities must have at least 10 reviews to qualify.
While there isn’t a specific metric for employee feedback, Statista said employee turnover rates are an indicator of staff satisfaction.
“We assume that lower turnover rates are associated with higher overall satisfaction among employees, as they tend to remain longer at their workplace,” Statista said. “Accordingly, nursing homes with lower turnover rates receive better scores for this measure.”
Having more time available per patient or resident also contributes to higher staff satisfaction and is closely linked to improved quality of care as well as greater resident satisfaction, Statista said.
Throughout the last six years, the ranking has changed. Some of the biggest changes include the addition of facilities with 50-99 and 99-149 beds, COVID-19 score, resident satisfaction score and accreditation score
Since the first ranking was published for 2020, America’s Best Nursing Homes has undergone several changes to better reflect the increased access to quality data.
In 2020, the ranking only lists facilities with 150+ beds in the top 20 states, based on population. The scoring model was 85 percent performance data and 15 percent reputation.
In subsequent rankings, more states and data sources were added.
After the pandemic, the 2021 list included a COVID-19 response score that was evenly weighted with performance and reputation. This includes data on the total number of COVID-19 cases and deaths and other indicators like necessary medical supplies and staffing.
The 2022 ranking included five more states and added data about residents’ vaccination rates to the COVID-19 score.
2023 saw another major change, switching from the 25 states with the highest populations to the 25 states with the highest number of facilities according to the Centers for Medicare & Medicaid Services. An accreditation score was also added to the scoring model to “reflect a range of structural and/or quality requirements which are now relevant to the nursing homes rankings.” This changed the scoring weight, with performance and reputation both at 35 percent, COVID-19 score at 25 percent and accreditation at 5 percent.
The scope of nursing homes grew in 2024, when facilities with 99 to 149 beds were included for the first time. A resident satisfaction score was also added to the model, incorporating data from The Joint Commission’s National Patient Safety Goals and Google reviews. This category measures the Joint Commission patient safety goals such as improved accuracy of patient identification and safety of medication use and reduced health care-associated infections and patient harm resulting from falls. With the addition of the new measure, making up 7 percent of the scoring model, the COVID-19 score dropped to 18 percent of the total score.
Last year, the ranking added facilities with 50-99 beds, removed the COVID-19 score and added metrics for administrative turnover and weekend staffing to the performance score. The total score was therefore 52 percent performance, 33 percent reputation, 30 percent reputation, 10 percent accreditation and 5 percent satisfaction, from Google reviews.
The current 2026 ranking includes 33 states in small, medium and large-sized nursing homes. Short- and long-term vaccination rates for seasonal influenza and the pneumococcal vaccines were also added in the quality metrics. Performance makes up 55 percent of the total score, followed by reputation at 30 percent, accreditation at 10 and resident satisfaction at 5 percent.
River Garden Hebrew Home is ranked No. 1 for large nursing homes in Florida and has been one of the most consistently highly ranked nursing homes on Newsweek’s lists throughout the years.
Located in Jacksonville, the facility is part of the larger River Garden Senior Services, which also offers independent living apartments, rehabilitative care, outpatient therapies and adult day care and memory care services on its campus. It has 180 beds, accepts Medicare and Medicaid and has both a resident and family council. The non-profit Jewish facility has been in operation for 80 years and is open to residents of all faiths, with a guiding principle inspired by the Fifth Commandment to “honor thy father and thy mother.”
As River Garden has evolved with new technology and challenges, CEO Mauri Mizrahi said that principle has remained constant.
“We talk about River Garden as a home because it is a home. It’s about people. It’s about people taking care of people, and I mean that in the broadest of [terms],” she told Newsweek in an interview. “We have staff taking care of residents, but I fully believe that my job is to take care of staff and help staff take care of each other, because if people feel valued, supported and cared for, then they are going to value support and care for the residents.”
Mizrahi started at River Garden in 2005 as a physical therapist but moved into leadership training in 2017 and took over as CEO in 2021, at the height of the COVID-19 pandemic.
Navigating the pandemic was a major challenge that has forever altered the way nursing homes run, Mizrahi said.
“Anybody who has led any piece of health care through that pandemic will never be the same,” she said. “It was life-altering and life-changing, not just people who led through health care, [but also] people who worked through health care.”
While health care has always been strictly regulated, Mizrahi said the pandemic brought on a heightened awareness about infection control, especially moving into the colder season when respiratory illnesses like influenza, COVID and RSV can pose a great risk to the vulnerable population in nursing homes.
Another pandemic challenge was staffing. Turnover was high during those times, but Mizrahi said retention has vastly improved to pre-pandemic numbers.
“Everybody was working super hard and, sometimes, at the end of the day, we were all working super hard and we didn’t stop and say, ‘you just did an amazing job today,'” Mizrahi said. “But I learned [to] acknowledge what we were doing and thank each other [and] have gratitude for the value that people were bringing every day.”
During the time when lockdowns were in place and visitors weren’t allowed, the staff became family to the residents and acted as their “connection to the outside world,” Mizrahi said. The staff also became family to each other, and recognition for the work they were doing during a difficult situation was greatly appreciated.
“You have to stop and value the work that everybody’s doing,” she said. “It doesn’t take much, it just takes a hug, a pat on the back, a thank you. Those are the most important lessons that I learned, and I continue to really try and lead that way today.”
