CMS Nursing Home 5-Star Ratings Explained
Understand the overall CMS rating, health inspections, staffing and quality measures—and the limits of a star score.
What the CMS star rating means
Medicare's Care Compare assigns participating nursing homes an overall rating from one to five stars. Five stars means the facility is rated much above average and one star means much below average within the CMS system. The score is a screening tool—not a guarantee of the experience a particular resident will have.
The overall rating brings together three areas: health inspections, staffing and quality measures. NursingHomes.us displays the overall score and the component ratings separately because two facilities with the same overall score can have very different strengths and risks.
1. Health inspections
Health-inspection results come from state survey agencies applying federal requirements. Look beyond the star: review the number, recency and severity of deficiencies, whether problems were corrected, and whether the facility has repeated citations across survey cycles.
2. Staffing
Staffing data helps you compare nursing hours per resident, the mix of registered nurses, licensed practical nurses and nurse aides, weekend coverage and turnover. A staffing star summarizes part of that picture, but the underlying hours and turnover can reveal differences hidden by a single score.
3. Quality measures
Quality measures summarize selected resident outcomes and care processes for short- and long-stay residents. They can include measures related to falls, pressure ulcers, antipsychotic use, emergency visits and rehospitalization. Not every measure applies to every resident, and reporting periods can differ from the latest inspection date.
How to use the rating responsibly
- Use the overall rating to create a shortlist, not to make the final decision.
- Compare health inspections, staffing and quality ratings separately.
- Read the most recent deficiencies and check severity and correction status.
- Review fines, payment denials, abuse indicators and Special Focus status.
- Visit the facility, speak with residents and families, and ask about current staffing.