Guide
Nursing Home Star Ratings Explained
The Medicare Five-Star rating is the most widely cited nursing home number, and it is genuinely useful once you know what it does and does not measure. Here is how it works.
What the Five-Star rating is
Medicare (through CMS) rates every certified nursing home from one to five stars. Five stars means much above average, one star means much below average, and three stars is around the middle. The rating is designed to help families compare facilities on a common scale.
The three components
The overall star rating is built from three separate ratings, each also on a one-to-five scale:
- Health inspections. Based on the last three years of on-site inspections and complaint investigations, weighted toward the most recent and most severe findings. This is the backbone of the rating.
- Staffing. Based on nurse hours per resident per day, including registered-nurse time, and on staff turnover, adjusted for how sick the residents are.
- Quality measures. Based on clinical outcomes reported for residents, such as pressure sores, falls, and mobility, drawn from assessment data.
How the overall rating is calculated
CMS starts with the health inspection rating, then adjusts it up or down based on staffing and quality measures. Strong staffing can add a star, and weak staffing can subtract one. Because inspections drive the result, two facilities with the same overall stars can still have very different inspection histories, which is why it pays to look underneath the number.
What the stars do not tell you
The rating is a helpful summary, but it has limits. It can lag real conditions, since inspections happen periodically. Some measures are self-reported. And a single overall number cannot capture everything about a specific unit or shift. It is a starting point, not a full picture.
Star ratings versus Google reviews
Medicare stars and Google stars are not the same thing and often disagree. Medicare stars measure inspections, staffing, and clinical outcomes. Google reviews measure the visitor and resident experience. A facility can score well on one and poorly on the other. For safety, rely on the Medicare data.
Open Care Data shows each facility's overall rating and all three component ratings, plus the underlying citations, staffing, and fines, on one page. Look up a nursing home or see how we turn this into a Safety Grade.
Frequently asked questions
What is a good nursing home star rating?
Four and five stars are above average, three stars is roughly average, and one and two stars are below average. Use the overall rating as a first filter, then check the health-inspection, staffing, and quality-measure components underneath it.
How is the Medicare nursing home rating calculated?
CMS starts with the health-inspection rating (from the last three years of inspections), then adjusts it up or down using the staffing rating and the quality-measures rating. Inspections carry the most weight, so facilities with the same overall stars can still differ.
What is the difference between the star rating and Google reviews?
The Medicare star rating measures inspections, staffing, and clinical outcomes. Google reviews measure the visitor and resident experience. They often disagree, and a high Google rating does not mean a facility is safe. Use the Medicare data for safety.
Are nursing home star ratings reliable?
They are a useful, standardized starting point based on real inspection and staffing data, but they have limits: they can lag current conditions, some measures are self-reported, and one number cannot capture every unit or shift. Confirm the rating against the underlying inspection and staffing details.