How the federal five-star rating for nursing homes is built, what each part measures, and what a star rating cannot tell you.
In this guide
- Where the stars apply
- The four ratings
- How to read them
- What the stars do not tell you
- Using the rating in your search
- If the home is not on Care Compare
- Sources
If you search for a nursing home, you will see a rating of one to five stars. It comes from the Centers for Medicare & Medicaid Services (CMS), the federal agency that runs Medicare and oversees nursing home rules. This guide explains what the stars are, what they leave out, and how to use them well.
Where the stars apply
The Five-Star Quality Rating System covers nursing homes certified by Medicare or Medicaid. It is published on Medicare's Care Compare website. It does not rate assisted living communities, home care agencies or memory care units that are not part of a certified nursing home. In California, assisted living is licensed by the state instead, and has no federal star rating.
The four ratings
Each nursing home gets an overall rating plus three separate ratings:
- Health inspections. Based on findings from on-site inspections by state surveyors, including complaint investigations. More serious or more widespread problems count against a home.
- Staffing. Based on nurse staffing hours per resident, adjusted for how sick the residents are. CMS has also added staff turnover and weekend staffing to what it reports.
- Quality measures. Based on information homes report about residents, such as falls, pressure ulcers and use of certain medications.
- Overall. A combined rating built from the three above. CMS publishes a Technical Users' Guide that explains the method.
CMS describes five stars as much above average quality and one star as much below average. The ratings are relative: a home is compared with others, with cut points that CMS publishes by state, so a star count is not a pass or fail grade.
How to read them
Look at the three parts, not only the overall number. A home with four overall stars and one star for staffing may deserve a closer look at who is on shift. A home with a low inspection rating may have had one bad inspection that was corrected, or repeated problems. The inspection report tells you which.
Check the date. Inspections happen on a schedule and after complaints, so a rating can be a year or more old. CMS changes how it calculates the ratings from time to time, and announces changes publicly.
What the stars do not tell you
CMS itself says no single rating covers every factor in choosing a nursing home. A star rating cannot show:
- Whether the home is good at what your relative needs, such as rehabilitation, dementia care or a specific language or culture.
- How the staff treat residents day to day.
- How easy it is for family to visit. A nearby home may serve someone better than a higher-rated home that is far away.
- Whether the home has a bed available, or accepts your payment source.
Ratings also rely partly on information the homes report themselves, so they are a starting point and not a verdict.
Using the rating in your search
- Start with Care Compare to build a short list, then read the full inspection reports for each home.
- Compare homes within the same area, since ratings are relative.
- Visit at different times of day, including a mealtime and a weekend if you can.
- Ask the home about staffing: how many residents each aide cares for on each shift, and how many staff have left in the past year.
- Call the California Long-Term Care Ombudsman program, which takes concerns from residents and families and can tell you how the facility is regarded locally.
- Ask residents and their families what life there is like.
If the home is not on Care Compare
Assisted living and residential care in California are licensed by the Department of Social Services, Community Care Licensing Division. Its facility search lists licence status, and the division takes complaints. Eria Cares shows licence and inspection information from official records where we have it.
Sources
- CMS, "Five-Star Quality Rating System" (cms.gov)
- Medicare.gov, Care Compare (medicare.gov/care-compare)
- California Department of Social Services, Community Care Licensing Division (cdss.ca.gov)
