What Medicare’s nursing home star ratings mean
How the overall star is built from inspections, staffing and quality measures, what one to five stars says about a home, and what the stars leave out. To look a home up, our free nursing home checker reads the same Medicare data by ZIP code; the box below opens it.
Where the ratings come from
The ratings belong to the Centers for Medicare & Medicaid Services (CMS) and are published on Medicare.gov Care Compare, the site that replaced the old Nursing Home Compare in 2020. They cover every nursing home certified to take Medicare or Medicaid, which is nearly all of them. CMS refreshes the data monthly.
Our nursing home checker reads the same CMS dataset (the Provider Data Catalog behind Care Compare) and translates it: the stars, the staffing hours compared with the state and national medians, and each inspection finding with its severity letter written out in words. We never rate facilities ourselves, and we never add claims about a facility that CMS did not publish.
How the five-star system works
The overall star is built from three separate ratings, and it is worth knowing what each one measures because they are not equally trustworthy.
Health inspections
State surveyors inspect each nursing home roughly once a year, plus whenever a complaint is investigated. Every deficiency they cite is weighted by how serious it was and how many residents it affected, over the last three inspection cycles with the most recent counting most. This is the most objective of the three ratings, because someone from outside the building found the problems. One catch: the health inspection stars are graded on a curve within each state. The top 10% of homes in a state get five stars and the bottom 20% get one, so a 3-star inspection rating in one state is not the same as a 3-star rating in another.
Staffing
Nurse hours per resident per day, taken from the payroll records facilities must submit, adjusted for how much care the residents need. It counts registered nurse hours separately from total nursing hours, and it now includes weekend staffing and staff turnover. Staffing is one of the strongest predictors of care quality in the research, which is why our checker shows the hours against the state and national medians instead of just the star.
Quality measures
Clinical measures such as falls with injury, pressure ulcers, antipsychotic use, and rehospitalisations, drawn from assessments the facility completes on each resident and from Medicare claims. Most of this is self-reported, which is why a home can polish its quality measures while the inspection record tells a rougher story.
What each star level means
| Stars | CMS label | How to read it |
|---|---|---|
| Much above average | Worth a tour. Still check the abuse icon and the staffing hours first. | |
| Above average | Worth a tour. Look at which component is pulling the rating up. | |
| Average | Middle of the pack for its state. The individual findings matter more than the star here. | |
| Below average | Read the deficiency list before visiting. Ask what changed since the last survey. | |
| Much below average | The bottom fifth of the state on inspections, or a serious finding. Needs a specific reason to stay on your list. |
The labels are CMS's own. Remember that "average" is relative to the state, not to any absolute standard of care.
What the stars leave out
- The date. A rating can rest on an inspection that is many months old. Check when the last survey happened.
- Who reported it. The quality measures come from the facility. The inspection findings come from the state. Weight them accordingly.
- What the day is like. Whether staff know residents' names, whether the afternoon activity actually happens, whether lunch is edible. No dataset sees that. Tours do, with our tour checklist and tour scorecard in hand.
- Ownership changes. A new owner can change a building quickly in either direction, and the rating lags.
The flags that matter more than the star
- The abuse icon. CMS marks homes cited for abuse, neglect, or exploitation that caused harm, or the potential for harm more than once. Treat it as disqualifying unless you learn something extraordinary.
- Special Focus Facility status. Homes with a persistent record of serious problems are placed in the Special Focus Facility program, or listed as candidates for it. Both are shown on Care Compare and in our checker.
- Fines and payment denials. CMS lists the penalties it has imposed in the last three years. Large or repeated fines are a pattern, not an accident.
- Staffing well below the state median. Fewer hands means slower response and more shortcuts. A 4-star home with thin staffing deserves more scepticism than a 3-star home with strong staffing.
- Repeat citations. The same category cited survey after survey, especially medication errors or resident harm, is the signal. One isolated low-severity citation from three years ago is noise.
Nursing home red flags goes deeper on each of these, and how to spot understaffing on a tour shows what thin staffing looks like in person.
How to look up a nursing home, in order
- Enter the ZIP in the box above, or search by name on Medicare.gov. Our checker lists every certified home in the area so you can compare the one you were told about with its neighbours.
- Look at the health inspection stars first, not the overall star. Then open the findings and read the severity letters: A to C are minor, G and above caused actual harm, J and above mean immediate jeopardy.
- Check the staffing hours against the state median. Registered nurse hours and total nursing hours per resident per day. This is the number most likely to predict the daily experience.
- Look for the abuse icon, Special Focus status, and fines. Any of these changes the conversation.
- Shortlist two or three and tour them, unannounced if you can, at a mealtime. How to check nursing home ratings properly covers how to read what you find, and the tour checklist covers what to look for in person.
Not sure a nursing home is even the right level of care yet? The free assessment works out what level of care fits before you spend a weekend on Care Compare. And when the question is money, what a nursing home costs in every state has the verified median figures.
Check the nursing homes near your parent
Medicare's ratings, staffing against the state and national medians, and every inspection finding in plain English, by ZIP.
Open the nursing home checker →Questions people ask
What happened to the Nursing Home Compare website?
Medicare folded Nursing Home Compare into a single site called Care Compare at medicare.gov/care-compare in 2020. The data, the five-star ratings, and the inspection reports are the same; only the name and the layout changed. People still search for the old name, which is why you see it everywhere.
Is a 5-star nursing home always a good one?
No. The overall star is a blend, and the quality-measure part of it is largely self-reported by the facility. A 5-star home can carry an abuse citation or below-average staffing, and the star will not tell you that. Look at the health inspection stars, the staffing hours, and the individual findings, then tour.
How often are nursing home star ratings updated?
CMS refreshes Care Compare monthly. Health inspection results move as new surveys are completed, staffing data comes from quarterly payroll reports, and quality measures update on their own schedule. A rating can change from one month to the next, so check the date on what you are reading.
Can I look up a nursing home by name?
On Medicare.gov you can search by name, city, or ZIP. Our nursing home checker works by ZIP code and lists every Medicare-certified nursing home in that area, so you can compare the one you were told about against its neighbours without knowing all their names.
Does Medicare rate assisted living communities?
No. Assisted living is licensed by each state, not certified by Medicare, so there is no federal star rating and no Care Compare listing. Your state licensing agency publishes inspection records, and our guide to checking an assisted living facility explains where to find them.
What do the letters A through L on inspection findings mean?
CMS grades every deficiency on a grid: how widespread it was (isolated, a pattern, or widespread) and how serious (from a paperwork-level problem with no harm, through actual harm, up to immediate jeopardy). A to C are minor, D to F had the potential for harm, G to I caused actual harm, and J to L mean residents were in immediate jeopardy. Our checker prints that meaning in words beside each finding.
Sources
- Medicare.gov Care Compare
- CMS: Five-Star Quality Rating System
- CMS Provider Data Catalog: nursing homes
- CMS: Special Focus Facility program
The ratings, staffing figures, and findings are CMS's own. We translate the public record into plain English and never rate facilities ourselves. This page is educational and is not medical or legal advice.