Nursing home star ratings, explained
Every nursing home that takes Medicare or Medicaid gets a 1-to-5 star overall rating from CMS, plus separate ratings for health inspections, staffing and quality measures (CMS Five-Star Quality Rating System, Technical Users' Guide (Sept 2026)). Here's how to read them.
Updated November 2026 · Sources linked in the text · General information, not medical, legal or financial advice.
The three parts of the rating
- Health inspections. Based on state inspection results. This rating is relative within each state: the top 10% of nursing homes in a state get five stars, the bottom 20% get one star, and the middle 70% are split evenly between two, three and four stars (CMS Five-Star Quality Rating System, Technical Users' Guide (Sept 2026)).
- Staffing. Based on nurse staffing hours per resident, and since 2022 also staff turnover and weekend staffing (CMS: Five-Star Quality Rating System).
- Quality measures. Based on how residents are doing on measures reported by the nursing home.
How the overall rating is calculated
CMS starts with the health inspection rating, adds a star if staffing is five stars (or takes one away if it's one star), then does the same for quality measures. The overall rating can't go above five or below one, and a one-star health inspection rating can only be raised by one star (CMS Five-Star Quality Rating System, Technical Users' Guide (Sept 2026)). In other words, inspections matter most.
Warning signs to look for
- Abuse icon. Shown when a nursing home was cited for abuse that harmed a resident, or for repeat abuse citations. Its health inspection rating is capped at two stars while the icon applies (CMS Five-Star Quality Rating System, Technical Users' Guide (Sept 2026)).
- Special Focus Facility (SFF). Nursing homes in CMS's Special Focus Facility program get no star ratings; Care Compare shows a warning sign instead (CMS Five-Star Quality Rating System, Technical Users' Guide (Sept 2026)).
- Fines and payment denials. Federal penalties are listed on each nursing home's page here and on Care Compare.
What the stars don't tell you
Ratings are a starting point. Visit in person, at different times of day, and ask about staffing on evenings and weekends, how care plans are made and how families are kept informed. Our nursing home pages show each home's ratings next to its state average, so you can compare like for like.
Quick answers
Are nursing home star ratings reliable?
They're the most consistent national comparison available, and inspections carry the most weight. Some data are reported by the nursing homes themselves, so use the ratings together with a visit and the latest inspection report (CMS Five-Star Quality Rating System, Technical Users' Guide (Sept 2026)).
How often are the ratings updated?
CMS refreshes Care Compare data regularly, and health inspection cut-offs are re-calibrated each month so the distribution within each state stays steady (CMS Five-Star Quality Rating System, Technical Users' Guide (Sept 2026)).
What does the trophy icon mean?
CMS shows it for high-performing nursing homes with fewer citations, higher staffing and other strong quality indicators (CMS Five-Star Quality Rating System, Technical Users' Guide (Sept 2026)).