How to read CMS star ratings
Key takeaways
- CMS rates most certified nursing homes from 1 to 5 stars. Five is the highest.
- The overall rating combines three ratings: health inspections, staffing and quality measures.
- Health inspection ratings are set within each state, so compare them across state lines with care.
- Stars do not cover price, openings or how residents and families feel about the home.
CMS gives most certified nursing homes an overall rating from 1 to 5 stars, built from three separate ratings: health inspections, staffing and quality measures. Five stars is the highest. Homes in the Special Focus Facility program, and homes too new to have two standard inspections, are not rated. The ratings do not cover price, openings or how residents and families feel about the home.
The four ratings
| Rating | What it is based on |
|---|---|
| Overall | A combination of the three ratings below. |
| Health inspections | What state inspectors found during on-site inspections and complaint investigations. |
| Staffing | Nurse staffing hours per resident per day and staff turnover, from payroll records the home submits to CMS, adjusted for how much care its residents need. |
| Quality measures | Clinical measures drawn from resident assessments and Medicare claims, such as falls with major injury and rehospitalizations. |
Three things to keep in mind
- Health inspection ratings are set within each state. CMS publishes separate cut points for every state, so a 4-star home in one state is not directly comparable with a 4-star home in another.
- The national average sits near the middle. In the current data the average overall rating is 3.0 of 5.
- A rating is a summary. Two homes with the same stars can differ a lot in staffing hours, turnover and what inspectors cited. Each home's page on this site shows those details beside the stars.
What the stars leave out
- What the home charges, and whether a bed is open now.
- Resident and family satisfaction.
- Anything that changed after the data was processed (Aug 1, 2026 for the figures on this site).
For the official record and CMS's own explanation of the method, see Medicare.gov Care Compare.