How to read a nursing home's Medicare star ratings
By ParentNextStep Editors · Updated October 14, 2026
Medicare rates every nursing home it certifies from 1 to 5 stars. Here's what goes into each rating, how the overall rating is built, and how to use the ratings without being misled.
The four ratings
Medicare's Care Compare gives every nursing home it certifies four ratings, each from 1 to 5 stars. Our nursing home pages show all four, using Medicare's own labels.
- Health inspections: what state inspectors found at the home's two most recent standard inspections, plus three years of inspections after complaints. Recent findings count more than older ones.
- Staffing: nurse hours per resident each day, from the payroll records homes send Medicare every quarter, adjusted for how much care the residents need, plus how often nurses and administrators leave.
- Quality measures: 15 measures of how residents do. For long-term residents these include falls with major injury, pressure ulcers, needing more help with daily activities and hospital stays. For short stays after a hospital visit they include returning to the hospital, emergency room visits and getting back home.
- Overall rating: Medicare's summary of the other three.
How the overall rating is built
The overall rating isn't an average. Medicare builds it in three steps:
- Start with the health inspection rating.
- Add a star if staffing is 5 stars; take one away if staffing is 1 star.
- Add a star if quality measures are 5 stars; take one away if they're 1 star.
So the overall rating mostly reflects inspections. A home with a 1-star inspection rating can move up by one star at most, however good its staffing and quality measures are.
Inspection stars are graded within each state
Inspections vary from state to state, so Medicare grades the health inspection rating on a curve within each state: the top 10% of homes get 5 stars, the bottom 20% get 1 star, and the rest are split into 2, 3 and 4 stars. A 3-star home in one state isn't directly comparable with a 3-star home in another. Staffing and quality measures use national standards.
Reading the staffing numbers
Next to the staffing rating, each of our nursing home pages shows the hours of nursing care per resident per day, beside the state and U.S. averages Medicare publishes (3.86 hours a day across the U.S. in Medicare's latest data, about 0.69 of them from registered nurses). Medicare cautions that these are averages and don't necessarily show how many staff are there at any given time. A home that doesn't send its payroll data, or that goes four or more days without a registered nurse, gets 1 star for staffing automatically.
Warning flags
- The abuse icon. Care Compare marks homes recently cited for harm or potential harm from abuse or neglect with a red icon and the words “This nursing home has been cited for abuse.” Their health inspection rating is capped at 2 stars, so their overall rating can't be higher than 4.
- Special Focus Facilities. A small number of homes with a persistent record of serious problems are in Medicare's Special Focus Facility program. They get a full inspection at least every six months and aren't rated: Care Compare says “This facility is not rated due to a history of serious quality issues.” Medicare also keeps a list of candidates for the program, the homes with the worst inspection results in each state.
What the ratings can't tell you
Medicare says star ratings “aren't a substitute for visiting the nursing home” and should be used with other information. Read the home's recent inspection citations (see what an inspection citation means), visit more than once, and bring questions to ask on a tour.
Look up a nursing home
Every certified nursing home has a page here with its four ratings, recent citations, fines and staffing. Start with nursing homes by state, or go straight to a state: