CMS launched the Nursing Home Five-Star Quality Rating System in 2008 to give consumers a simple way to compare facilities. The system has improved significantly since then, but it still has limitations every family should understand.
The Three Components
Each nursing home receives a separate rating for three domains, which are then combined into an overall rating:
- Health Inspections (weighted most heavily): based on the 3 most recent annual inspections plus any complaint investigations. Covers deficiency counts, scope, and severity.
- Staffing: based on CMS-reported RN, LPN/LVN, and CNA hours per resident day, adjusted for resident acuity using the MDS assessment data.
- Quality Measures: based on 15 quality metrics including rates of pressure ulcers, falls, hospitalizations, use of antipsychotic medications, and pain management.
Why the Overall Rating Can Mislead
Similarly, some facilities improve their star ratings by focusing on the metrics CMS measures while neglecting unmeasured factors like resident dignity, family communication, and activity programming quality.
What the Stars Don't Measure
- Financial stability of the facility or ownership group
- Staff turnover rates (though CMS has been adding turnover data)
- Food quality and dining experience
- Outdoor access and environmental quality
- Culture change and person-centered care philosophy
How to Use Ratings Effectively
Use star ratings as a first filter. Eliminate 1- and 2-star facilities unless there's a compelling geographic reason. Then dig into the inspection reports for any facility you're seriously considering. Look at the trend over 3 years: is a facility improving or declining?
CareScope displays all three component ratings alongside overall stars. Use our compare tool to put facilities side by side across all dimensions.
See our national rankings or search by star rating in your area.