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CMS uses a 5-star rating system based on three components: health inspections (weighted most heavily), staffing levels, and quality measures. Each component gets its own star rating, and these are combined into an overall rating. Facilities are rated on a curve relative to other facilities in their state.

A 5-star facility is rated 'Much Above Average' compared to other nursing homes in the state. It indicates strong performance across health inspections, nurse-to-resident staffing ratios, and clinical quality measures like pressure ulcer rates and medication management. Always verify with an in-person visit.

Start by checking overall CMS ratings and any recent health inspection deficiencies. Visit in person to assess cleanliness, staff friendliness, and resident engagement. Ask about nurse staffing ratios, staff turnover rates, and how the facility handles medical emergencies. Compare at least 2–3 facilities before deciding.

Deficiency citations are violations found during state health inspections, ranging from minor paperwork issues (Scope D) to widespread, immediate jeopardy situations (Scope J–L). Facilities with repeated immediate-jeopardy citations or payment penalties are flagged as Special Focus Facilities by CMS.

Medicare covers short-term skilled nursing facility care (up to 100 days) after a qualifying 3-day hospital stay. Days 1–20 are fully covered; days 21–100 require a daily co-pay ($204/day in 2024). Long-term custodial care is not covered by Medicare. Medicaid covers this for those who qualify based on income and assets.

Key questions include: What is your nurse-to-resident ratio on nights and weekends? What is your staff turnover rate? How do you handle care plan changes? Have you received any payment denials from Medicare in the past year? Can I speak with a current resident or family member? What is the process for filing a complaint?

Special Focus Facilities (SFF) are nursing homes identified by CMS as having a pattern of serious quality problems. They receive more frequent inspections (every 6 months instead of annually) and face stricter oversight. Check CareScope's inspection records to see if a facility has SFF status before choosing.