Of the nation’s five most populous metropolitan areas, Houston has by far the fewest top quality nursing homes, according to new rankings released by U.S. News and World Report.

The annual rankings utilize government data to consider nearly 100 major metropolitan areas nationwide. The facilities that have recently been awarded five stars by the Centers for Medicare & Medicaid Services’ Nursing Home Compare system are designated “best nursing homes.” The magazine issued its latest rankings Wednesday.

Overall, about 25% of the considered nursing homes were five-star facilities, U.S. News reported. This is a notable increase from 19% a year ago.

The largest cities in the country generally posted even more impressive numbers. Of New York City’s nursing homes, more than 36% earned five stars. Philadelphia came next (36%), followed by Los Angeles (24%) and Chicago (21%).

However, only about 9% of Houston’s nursing homes ranked among the “best.”

Houston also had the fewest nursing homes among the top five metros, at 160. Philadelphia came next, at 295.

Developers already have zeroed in on Houston as a hotspot for long-term care demand. It is the city with the most senior housing properties under construction, according to a 2013 report from the National Investment Center for the Seniors Housing & Care Industry.