What Does the SunsetWell Score Mean?
Understanding our predictive quality ratings
Overview
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:
1. SunsetWell Score (0-100)
Absolute healthcare quality measure
2. Percentile Rank (0-100)
How this facility compares to peers in your state
Understanding Your Two Scores
1. SunsetWell Score: Absolute Healthcare Quality
What it measures: How good is this facility at preventing adverse health events?
The score range:
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.
2. Percentile Rank: How You Compare to Local Options
What it measures: How does this facility compare to other nursing homes you might be considering in the same state?
The percentile range:
Example: 85th percentile in California means this facility ranks better than 85% of California nursing homes (top 15%).
Why Two Numbers Matter
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?"
Scenario A: Competitive Market
Facility in San Francisco, CA
- SunsetWell Score: 78 (Very Good absolute quality)
- Percentile: 60th (Above average in very competitive market)
This is a good facility, but CA has many excellent options. You might find better nearby.
Scenario B: Less Competitive Market
Facility in rural Wyoming
- SunsetWell Score: 78 (Very Good absolute quality)
- Percentile: 95th (Top 5% in this market)
This is a good facility AND it's one of the best available in your area. Strong choice.
How We Calculate the Score
Data Sources
We analyze quality metrics from:
- CMS Medicare.gov: Official federal nursing home data
- Health Inspections: Survey deficiencies and violations
- Staffing Information: Nurse hours per resident, turnover rates
- Quality Measures: Clinical outcomes reported to CMS
- Safety Outcomes: Substantiated complaints and facility-reported incidents
All data comes from publicly available federal sources.
Our Predictive Harm Model (v2.3)
We use machine learning to analyze data from all 14,752 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.
Validation testing shows the SunsetWell Score outperforms CMS 5-star ratings at predicting patient harm, with particularly strong performance on per-facility complaint rates (correlation: 0.63 vs 0.56). Our latest v2.3 model represents a 50% improvement over previous approaches.
Our approach: We weight inspection severity (strongest predictor), staffing depth and stability, clinical harm measures (MDS quality indicators), and facility-specific complaint/incident rates using optimized weights validated against real outcomes.
How the SunsetWell Score Compares to CMS Stars
CMS 5-Star Rating
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)
SunsetWell Score
Predictive Harm Model (v2.3)
A 0-100 score predicting patient harm risk using machine learning trained on actual harm outcomes (falls with injury, pressure ulcers, UTIs, antipsychotics, complaints). Outperforms CMS stars with stronger correlations to adverse events.
When to use it:
Compare facilities that pass your CMS threshold to identify which will most likely keep your loved one safe
Using Both Ratings Together
- Filter with CMS Stars: Eliminate facilities with 1-2 stars (serious compliance issues). Consider only 3-5 star facilities.
- Compare with SunsetWell Score: Among acceptable facilities, use our score to rank by predicted safety. Use the percentile to understand local market context.
Frequently Asked Questions
Is the SunsetWell Score official?
No. CMS 5-star ratings are the only official federal ratings. Our score is analytical research based on publicly available CMS data.
Why is your score different from CMS?
CMS uses a simple formula (add/subtract stars) focused primarily on process metrics. We use machine learning trained on actual patient harm outcomes (falls with injury, pressure ulcers, infections, complaints). Our v2.3 model consistently outperforms CMS stars at predicting which facilities will have adverse safety events, with particular strength on per-facility complaint rates (correlation 0.63 vs 0.56).
Can facilities game your score?
We don't disclose our exact analytical methods or weightings to mitigate this risk. However, the underlying principle is that facilities that improve actual quality (better inspections, lower turnover, adequate staffing) will score higher.
Which rating should I trust more?
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).
How often are scores updated?
We recalculate scores quarterly when CMS releases new data.
Coverage & Limitations
Current Coverage
- 14,752 nursing homes scored (100% of all Medicare-certified SNFs) ✅
- 39,463 assisted living facilities scored (88.4% of US ALFs)
Our v2.3 model achieves complete coverage through robust handling of missing data and validated feature engineering.
Updates
Scores are recalculated quarterly when CMS releases new data.
Current score version: v2.3 "Predictive Harm" (launched October 2025)
Important Notes
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.
Legal Disclaimer
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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