How the CMS nursing home star ratings work

Five stars summarise inspections, staffing and clinical quality measures.

The three components

Health inspections come from state surveyors' unannounced visits over the last three years: deficiencies, their scope and severity. Staffing compares nurse hours per resident per day — including registered nurses on weekends — against expected levels for the facility's residents. Quality measures track outcomes such as falls with major injury, pressure ulcers, antipsychotic medication use and successful return to the community.

The overall rating

The overall star rating is derived from the three component ratings, with health inspections weighing most heavily. A facility can earn 4 or 5 stars overall while still having a weak staffing component, so read the components separately rather than only the headline number.

Flags to look for

An abuse icon means the facility was cited for abuse during the last three survey cycles. Special focus status identifies facilities with a history of serious quality problems that CMS monitors more closely. High-performing flags facilities that performed well on a broad set of measures.

What the ratings do not capture

Staff turnover, administrator changes, culture, food, activities and how a facility feels on a visit are not in the star rating. The pages here show turnover and administrator changes alongside the stars so the picture is fuller.