Five dimensions. One composite.
SilverScore does not reduce facility quality to a single number. A single composite suffers from aggregation loss, hiding the variance structure that institutional buyers need to see.
The rating family consists of four dimension-level scores covering clinical outcomes, operations, workforce, and reputation, plus a top-level composite for summary use cases. This structure mirrors the evolution of FICO from a single number to a family of industry-tuned scores, and is scientifically justified because each dimension has a distinct improvement pathway.
Clinical Quality
Outcomes that reflect the care delivered.
- Hospitalization rates (all-cause and avoidable), rolling 12-month window
- 30-day readmission patterns following facility transfers
- Emergency transport frequency and distribution by reason
- Fall rates (with and without injury), trend over 18 months
- Wound and pressure injury incidence
- Medication error signals from regulatory and voluntary reporting
Risk-adjusted for resident acuity mix (dementia severity, functional status, chronic condition burden) using published crosswalks from public data where available.
Operational Excellence
The signals that separate well-run buildings from barely-running ones.
- Occupancy trajectory (12 and 36 month windows, noise-filtered)
- Length of stay by care level, relative to peer benchmark
- Move-out reason distribution (planned vs care-failure vs financial)
- Care level progression patterns and timing
- Census stability through seasonal and market variation
Peer-benchmarked against comparable facility size, care mix, and market conditions. Adjustment methodology published alongside the rating.
Staffing Adequacy
Staff-to-resident ratios and coverage are the strongest available leading indicator of quality.
- Total staffing hours per resident day (CMS PBJ-derived)
- Registered Nurse coverage hours per resident day
- Occupancy pressure relative to staffing baseline
- CMS staffing star rating (4-5 indicates adequate; 1-2 flags inadequate)
- Roadmap: turnover by role, consistency of assignment, training completion, and wage percentile enter the methodology when PBJ payroll-level integration lands.
Segmented by facility scale and CMS rating peer cohort. Today the dimension rewards adequate ratios + coverage; the future expansion adds tenure and turnover signals.
Reputation & Satisfaction
Normalized, noise-corrected signals from the people who use the facility.
- Family sentiment from partner satisfaction surveys (where data partnerships exist)
- Resident-reported quality signals
- Consumer review data, weighted for recency and volume, noise-filtered for manipulation
- Complaint records from state regulators and ombudsman offices
- Regulatory action history and resolution
Review data is weighted inversely to its susceptibility to manipulation. Survey data with transparent methodology weighs heavier than open-platform reviews.
Composite SilverScore
The summary signal. Built from the sub-scores with published weighting.
- Weighted combination of the four dimension scores
- Published weighting scheme, versioned and council-reviewed
- Confidence band reflecting data completeness across contributing dimensions
- Trend indicator showing 12-month trajectory
The composite is designed for quick-reference use (discharge routing, consumer lookup, portfolio summary). Institutional buyers making high-stakes decisions should use the dimension-level scores directly.
Exact weightings, risk-adjustment parameters, and cut-points are maintained by the methodology team under advisory council oversight. The weighting scheme is published at each quarterly release and changes are logged in the methodology version archive.
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