CMS Issues Star Quality Rating System for Nursing Home Compare

The Centers for Medicare & Medicaid Services (CMS) now has quality ratings for each of the nation’s 15,800 nursing homes that participate in Medicare or Medicaid.  Facilities are assigned star ratings from a low of 1 star to a high of 5 stars based on health inspection surveys, staffing information, and quality of care measures. The ratings are publicly available on the agency’s Nursing Home Compare website at

You can search for nursing homes by state, county, or city, or by a specific nursing home’s name. For example, in searching for nursing homes in Oakland, California, 20 results come up with the easy-to-view star ratings on each nursing home. It also lists whether the nursing home participates in Medicare and/or Medicaid, how many beds the facility has, and its type of ownership (i.e. whether it is for profit or non profit).

Of the 20 nursing homes that came up in Oakland’s search – 12 of 20 (or 60%) had an overall rating of 4-5 stars, 25% had a rating of only 1-2 stars.

Such a quality rating system provides families with a relatively easy-to-navigate, straightforward assessment of nursing home quality. The website has suggested questions for beneficiaries and their family members to ask nursing homes, and also has additional information on paying for nursing home care and alternatives to nursing homes.

Based on consultations with academic experts, patient advocacy and nursing home provider groups, CMS developed the rating system based on each nursing home’s performance in 3 critical areas:

  • Health inspection surveys   Each year state and federal surveyors conduct about 15,800 on-site, comprehensive assessments of each nursing home’s health care services and compliance with federal/state rules.   These surveys are designed to help protect the health and safety of residents, including resident’s rights and general quality of life. Surveyors also conduct about 50,000 complaint investigations each year.  Information from the most recent three years of survey findings were used to develop the ratings.
  • Quality measures The quality rating system uses 10 key quality measures out of the 19 that can be found on the Nursing Home Compare website.  Areas examined include the percent of at-risk residents who have pressure ulcers (bed sores) after their first 90 days in the nursing home, the number of residents whose mobility worsened after admission, and whether residents received the proper medical care.
  • Staffing information There is strong evidence that low staffing levels can comprise the level of patient care in a nursing home and is considered an important indicator of quality.  This measure reports the number of hours of nursing and other staff care per patient per day.  This measure is adjusted to account for the level of illness and services required by each facility’s residents.

A 5 star designation means the facility ranks “much above average,” 4 star indicates “above average,” 3 means “about average,” 2 is a “below average” ranking with a 1 indicating that a facility ranks “much below average.”  Rankings are dynamic and will be updated monthly.

In this first round of quality ratings about 12% of the nation’s nursing homes received a full 5 star rating while 22% scored at the low end with one star.  The remaining 66% of facilities were distributed fairly evenly among the 2, 3 and 4 star rankings.

CMS also publishes a list of the nation’s nursing homes with consistently poor performance records.  Nursing homes selected as such “Special Focus Facilities (SFF)” are provided with increased oversight, including onsite inspections that occur twice as often as better performing homes.  Homes with the SFF designation are clearly marked on the Compare website.

CMS recently published an updated version of its Guide to Choosing a Nursing Home which can help families through the process. You can also find up-to-date information about hospitals at Hospital Compare and dialysis clinics at Dialysis Facility Compare, as well as information about Medicare health and prescription drug plans.

You can also see our website for more information on options long-term care, including some information on nursing homes.

Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA’s Communications Director. With a Masters in Public Health from UC Berkeley, she is the online “public face” of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a “communicator” and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.