How to check nursing home ratings properly

The five-star rating is a decent screen and a terrible final word. Ten minutes on the data behind it tells you far more than the stars do.

What the stars actually measure

Medicare's Care Compare rating (medicare.gov/care-compare) combines three components: health inspections (state survey results, the most objective piece), staffing (nurse hours per resident per day), and quality measures (largely self-reported by facilities). The overall star is a blend, which means a facility can polish self-reported measures while inspections tell a rougher story. Always look at the components, not just the headline.

The one number to check first

Nurse staffing hours per resident per day, compared to the state average. Staffing is one of the strongest predictors of care quality in the data; more hands means faster response, fewer shortcuts, fewer bad days. A 4-star facility with below-average staffing deserves more skepticism than a 3-star with above-average staffing.

How to read deficiency reports

Every facility has some deficiencies; inspections are designed to find them. What matters: severity (was there actual harm, or paperwork?), pattern (the same category cited repeatedly across surveys), and recency. One isolated low-severity citation from three years ago is noise. Medication errors cited twice in two years is signal.

The flags that end the conversation

An abuse citation icon, large fines, or payment denials are Medicare's own red flags; treat them as disqualifying unless you learn something extraordinary. Our guide to nursing home red flags goes deeper.

What ratings can't see

Whether staff know residents' names. Whether the 2pm activity actually happens. Whether lunch is edible. That's what tours are for, with our free 25-question tour checklist in hand. And our Facility Checker translates all of the above into plain English for nursing homes near your ZIP.