The Medicare 5-Star Rating System

Medicare's Nursing Home Compare uses a 5-star rating system where 5 stars indicates "much above average" and 1 star means "much below average." The overall rating is based on three components:

What it measures:

Evaluates clinical care quality, infection control, medication management, and resident safety.

How to read it:

Look for patterns of serious violations rather than minor one-time issues. Recent inspections matter more than old ones.

Health Inspections

Based on results from annual state health inspections and any complaint investigations.

What it measures:

Higher staffing levels generally correlate with better care outcomes and fewer preventable problems.

How to read it:

A 5-star staffing rating doesn't guarantee quality, but very low ratings (1-2 stars) suggest lower hours available for patient care.

Staffing Ratings

Based on results from annual state health inspections and any complaint investigations.

What it measures:

Tracks things like pressure ulcers, falls, catheter use, antipsychotic medication use, and other quality indicators.

How to read it:

Compare facilities' rates to state and national averages. Look for improvement trends over time.

Quality Measures

Clinical outcomes based on resident assessments and standardized health measures.

Reading Inspection Reports Effectively

Clinical outcomes based on resident assessments and standardized health measures.

Look for Patterns

One-time violations may be less concerning than repeated issues or patterns of similar problems across multiple inspections.

Access Full Inspection Reports

Don't rely solely on star ratings. Read the complete inspection reports available on Medicare's Nursing Home Compare website.

Understand Severity Levels

Violations are categorized by severity. "Immediate jeopardy" findings are the most serious and should be heavily weighted.

Check Correction Timelines

Review how quickly the facility corrected deficiencies. Fast, thorough corrections indicate responsive management.

Important Limitations to Know

⚠Ratings are retrospective: They reflect past performance, not current conditions. Recent changes in ownership or management may not be reflected.

⚠Not all problems are captured: Inspections are scheduled and may miss issues that occur between visits.

⚠Quality varies within facilities: A good overall rating doesn't guarantee every resident receives excellent care.

⚠Use as a starting point: Ratings should inform your research but never replace in-person visits and direct observation.

Additional Resources

State Survey Agency Reports:

Your state health department maintains detailed inspection records

Long-Term Care Ombudsman:

Advocates who can provide insight into facilities in your area

Medicare's Nursing Home Compare:

Official database with ratings, inspection reports, and complaint histories