Five-Star Quality

CMS created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily and to help identify areas about which you may want to ask questions.

The Nursing Home Compare Web site features a quality rating system that gives each nursing home a rating of between 1 and 5 stars.  Nursing homes with 5 stars are considered to have much above average quality and nursing homes with 1 star are considered to have quality much below average.  There is one Overall 5-star rating for each nursing home, and a separate rating for each of the following three sources of information:

• Health Inspections – The health inspection rating contains information from the last 3 years of onsite inspections, including both standard surveys and any complaint surveys.  This information is gathered by trained, objective inspectors who go onsite to the nursing home and follow a specific process to determine the extent to which a nursing home has met Medicaid and Medicare’s minimum quality requirements.  The most recent survey findings are weighted more than the prior two years.  More than 180,000 onsite reviews are used in the health inspection scoring nationally.
• Staffing – The staffing rating has information about the number of hours of care provided on average to each resident each day by nursing staff.  This rating considers differences in the levels of residents’ care need in each nursing home.  For example, a nursing home with residents who had more severe needs would be expected to have more nursing staff than a nursing home where the resident needs were not as high.
• Quality Measures (QMs) – The quality measure rating has information on 11 different physical and clinical measures for nursing home residents.  The rating now includes information about nursing homes’ use of antipsychotic medications in both long-stay and short-stay residents.  This information is collected by the nursing home for all residents.  The QMs offer information about how well nursing homes are caring for their residents’ physical and clinical needs.  More than 12 million assessments of the conditions of nursing home residents are used in the Five-Star rating system.

Caution: No rating system can address all of the important consideration that go into a decision about which nursing home may be best for a particular person.  Examples include the extent to which specialty care is provided (such as specialized rehabilitation or dementia care) or how easy it will be for family members to visit the nursing home resident.  As such visits can improve both the residents’ quality of life and quality of care, it may often be better to select a nursing home that is very close over one that may be, compared to a higher rated nursing home that would be far away.  Consumers should therefore use the Web site only together with other sources of information for the nursing homes (including a visit to the nursing home) and State or local organizations (such as local advocacy groups and the State Ombudsman program).

In the Downloads section below, the Five-Star Quality Rating System Technical Users’ Guide provides in-depth descriptions of the ratings and the methods used to calculate them.  Beginning with the March 2009 version, the Technical Users’ Guide consists of two documents:  the Five-Star Quality Rating System Technical Users’ Guide and the Five Star Quality Rating System State-Level Cut Point Tables.  In addition, beginning with March 2009 we have posted a data file that contains reported, expected, and adjusted staffing time values for all nursing homes on Nursing Home Compare – Updated March 2018.