Medicare’s nursing home rating system is designed to help consumers compare nursing homes, identify quality differences, and spot areas of concern.

While Medicare usually doesn’t cover long-term nursing home care, it may cover short-term stays in a nursing home under Part A.

To help beneficiaries make informed decisions about care, Medicare created a rating system that you can use to evaluate and compare nursing homes.

The rating system can offer a useful starting point for your research. But it should not replace an in-person visit to a prospective facility and conversations with staff, residents, and their family members.

Learn how to use Medicare’s nursing home rating system to make informed care decisions.

Medicare rates nursing homes on a scale of 1 to 5 stars, where 1 star is the lowest and 5 stars is the highest. A rating of 3 stars means a facility is average.

Ratings reflect a facility’s performance in three key areas:

  • health inspections
  • staffing
  • quality measures

Medicare rates each facility on these three metrics and then aggregates scores into an overall rating.

Health inspections

The health inspection rating is based on yearly surveys performed by independent agencies over the past 3 years.

There are three types of inspections that make up the health inspection star rating. These include:

  • Health inspections: State inspectors evaluate whether a facility complies with Medicare and Medicaid regulations.
  • Complaint inspections: State Survey Agencies follow up on complaints from residents or their family members and evaluate the quality of care at the facility in question.
  • Infection control inspections: Inspectors evaluate a facility’s infection control measures.

Any reports resulting from these inspections are made available on the nursing home’s Medicare page (see the “How to use the ratings” section).

Staffing

The staffing rating reflects the daily hours worked by different types of staff members and staff turnover.

The ratings include a breakdown of how much time each type of staff member can spend with each resident each day. Types of staff include:

  • registered nurses
  • licensed practical nurses and licensed vocational nurses
  • nurse aides
  • physical therapists

These measures are designed to give you a sense of how much face time residents have with staff members based on the ratio of staff to residents.

The turnover numbers convey how long a nursing home retains its staff. Low turnover indicates that employees stay longer, which reflects better on the facility.

Quality measures

The quality measures rating is based on data that Medicare collects regarding the care residents receive in nursing homes.

It includes short-stay and long-stay resident outcomes on factors like falls, infections, pressure ulcers, and antipsychotic use.

Medicare.gov has a Care Compare search tool that allows users to view a list of nursing homes in their area.

To use the tool, enter your ZIP code and click “Search.” It will return a list and a map of nearby facilities with their corresponding star rating.

The “Compare” feature allows you to compare three facilities side-by-side. This is a useful feature, as it presents key information in an easily digestible format.

When you select an individual nursing home from the list, you can see a detailed breakdown of its star rating across the three metrics of health inspections, staffing, and quality measures.

This breakdown includes reports from recent health inspections and comprehensive staffing information and quality information, which you can compare against national and state averages.

Further, the facility profile page includes additional information such as COVID-19 vaccination rates, emergency preparedness, and penalty records.

Warning icons

If you see a circular red icon with a hand in its center beside a facility’s name in the list of results, it indicates that the facility has been cited for abuse.

If you see a triangular yellow icon with an exclamation mark in its center, it indicates that the facility has a history of significant quality issues.

Ratings can help you narrow your search and give insight into a nursing home’s performance, but they don’t offer a complete picture.

It’s entirely possible that resident and family satisfaction may not match ratings. A facility that scores well on official metrics may offer an unpleasant experience to residents. Conversely, a facility with a low star rating may be a positive environment for its residents.

Such a disparity could result from factors that are not measured in star ratings, such as:

  • facility culture
  • staff attitudes
  • special programs
  • amenities

Plus, location, convenience, and fit for specific needs are not reflected in ratings and could all contribute to your decision making.

Remember, ratings can be a helpful starting point for your research, but they should not be the only deciding factor.

Use ratings alongside direct observation, expert input, and personal priorities.

Ideally, your research would include on-site visits and conversations with staff, residents, and their family members.

If you have any questions, contact Medicare at 800-633-4227 (TTY: 877-486-2048).