Nursing home quality varies enormously — and the ratings are public. Knowing how to read and compare official quality measures helps you avoid underperforming facilities and find one where your loved one will truly thrive.
The CMS Five-Star Quality Rating System
The Centers for Medicare & Medicaid Services (CMS) rates every Medicare and Medicaid-certified nursing home using a 1–5 star overall rating, based on three component scores:
- Health Inspections (weighted most heavily): Based on results of the most recent 3 years of state inspections. Fewer and less severe deficiencies = higher score.
- Staffing: RN hours per resident day and total nurse staffing hours per resident day, adjusted for resident acuity. Higher staffing = higher score.
- Quality Measures: 15 clinical indicators including pressure injury rates, fall rates, rehospitalization rates, and appropriate use of antipsychotics.
All ratings are available free at Medicare.gov Care Compare.
Which Star Rating Component Matters Most?
Research consistently shows that staffing ratings are the strongest predictor of actual care quality. A facility can have a high overall star rating while having mediocre staffing if its inspection and quality scores are high. Always check the staffing star rating separately.
The staffing rating now incorporates weekend staffing data submitted to CMS, which often reveals that facilities cut staff on weekends — a significant quality issue.
Other Quality Data Sources
- Newsweek Best Nursing Homes Rankings: Annual rankings based on peer recommendations, patient experience surveys, and quality measures. Learn about Newsweek rankings →
- AHCA Quality Awards: The American Health Care Association awards Bronze, Silver, and Gold Quality Awards to facilities demonstrating performance excellence. Learn about AHCA awards →
- U.S. News Best Nursing Home Rankings: Combines CMS data with additional quality indicators
- State inspection reports: The full text of inspection findings, downloadable from Care Compare
Frequently Asked Questions
Q: How often are nursing home star ratings updated?
A: Staffing data is updated monthly. Quality measure data is updated quarterly. Health inspection ratings are updated after each inspection cycle (approximately annually).
Q: Is a 5-star nursing home always better?
A: Generally yes, but star ratings are one input — not the whole picture. Visit in person, read the actual inspection report, and trust your observations.
Related Resources
April 19, 2026
