How to Read Nursing Home Star Ratings, Reviews and Inspection Reports
Learn what Medicare's five-star nursing home ratings measure, where they fall short, and how to read state inspection reports and online reviews like a pro.
Medicare's Care Compare gives each certified nursing home an overall rating of one to five stars, built from three parts: health inspections, staffing and quality measures. The stars are a useful starting filter, but they are not a guarantee. The most valuable information is in the detailed inspection reports, the staffing data and what you observe in person. A facility with four stars can still have a recent serious problem, and a two-star facility may be improving, so look beneath the number.
Where to find the ratings
Care Compare is available through Medicare.gov. Search by ZIP code, then open each facility's profile. You will see an overall rating plus separate ratings for health inspections, staffing and quality measures. The profile also lists ownership, fines, payment denials, abuse citations and complaint information, and links to the full inspection reports. Information is refreshed on a regular schedule, so always check the date shown.
The three parts of the rating
| Component | What it measures | Strengths | Limits |
|---|---|---|---|
| Health inspections | Findings from standard annual surveys, complaint investigations and infection control reviews over roughly the last three years, weighted toward recent surveys | Based on on-site inspectors | A snapshot; inspectors visit only periodically |
| Staffing | Hours of nursing care per resident per day, including registered nurse hours and weekend staffing, plus turnover information | Uses payroll-based data submitted by facilities | Self-reported data and averages can hide bad days or shifts |
| Quality measures | Clinical outcomes drawn from resident assessments, such as pressure injuries, falls with injury, antipsychotic medication use and hospitalizations | Tracks results for residents | Relies on facility assessments, which can be inaccurate |
The overall rating starts with the health inspection rating and then adjusts up or down depending on staffing and quality measures. CMS periodically updates the methodology and thresholds, which can change many facilities' stars at once, so a rating drop does not always mean care changed overnight.
Reading an inspection report
Each state survey agency, working for CMS, inspects nursing homes at intervals that average around once a year, with additional visits triggered by complaints and incidents. The results are recorded on a federal form often called the CMS-2567, or a state equivalent. Key concepts:
- Deficiency (citation): A finding that the facility failed to meet a federal requirement. Each has a tag number that refers to a regulation.
- Scope and severity: A letter grade from A to L. The scale combines how serious the harm was (no harm, potential for harm, actual harm, immediate jeopardy) and how many residents were affected (isolated, pattern, widespread). A and B are minor and isolated, while J, K and L signal immediate jeopardy to residents' health or safety.
- Immediate jeopardy: The most serious category, meaning residents were at risk of serious injury, harm, impairment or death.
- Plan of correction: The facility's written plan to fix the problem, and a revisit by surveyors in some cases.
- Substandard quality of care: A designation for certain patterns of serious deficiencies.
When reading the narrative, look for the details. A citation for a delayed care plan update is different from a citation for a resident with a pressure injury who was not repositioned. Pay attention to repeated issues over multiple years, which indicate systems problems rather than one-time mistakes.
Penalties and special programs
Care Compare lists civil money penalties and payment denials. A few fines might be unremarkable at a large facility, but large fines or repeated penalties are a red flag. CMS also maintains a Special Focus Facility program for homes with a history of serious quality problems, and homes are listed on the site. A facility may be a candidate or a current participant; both statuses deserve scrutiny. A facility with a red abuse icon on Care Compare has been cited for abuse in recent surveys, and you should read the details.
How to use staffing data
Staffing is the strongest lever on quality, so look at the staffing details rather than just the star. Check the nurse aide hours per resident per day, registered nurse hours, and the weekend staffing figure, which is often lower. Ask the facility how many residents each aide cares for on each shift. A federal minimum staffing rule was finalized in 2024, but it faced legal challenges and congressional action and should not be treated as in force; check CMS for the current status. Also ask about turnover, since a revolving door of staff undermines continuity.
Online reviews and word of mouth
Reviews on consumer websites can be helpful for patterns but unreliable individually. Use these tips:
- Look for recurring themes over a long period, such as repeated mentions of call lights, lost belongings or helpful nurses.
- Be skeptical of very recent bursts of five-star or one-star reviews.
- Remember that families write when they are very pleased or very upset.
- Check responses from management; defensive replies can be telling.
- Ask the long-term care ombudsman about complaint patterns. Ombudsmen see issues that never reach public ratings.
Putting it all together: a simple scorecard
Create a one-page comparison for each finalist:
| Item | Where to find it | Notes |
|---|---|---|
| Overall, inspection, staffing and quality stars | Care Compare | Record each and the date |
| Number of deficiencies and any J, K or L | Inspection report | Note repeats |
| Fines and payment denials | Care Compare | Amount and dates |
| Abuse icon or Special Focus status | Care Compare | Yes or no |
| Staff hours per resident and weekend staffing | Care Compare | Compare to state average |
| Turnover | Ask facility or Care Compare | Percentage if available |
| Ombudsman comments | Phone call | Summarize |
| Your visit impressions | Tour checklist | Rate 1 to 5 |
If the star rating and your own observations disagree, trust the evidence you can verify. See how to choose a nursing home for how this fits into the full decision.
Limits to remember
Ratings lag reality because inspections are periodic and quality data are updated on a schedule. Data errors and self-reporting can distort results. Short-term rehab and long-term units in the same building may have very different experiences. The only way to know how care feels is to visit, ask questions and speak with residents and families.
Frequently asked questions
Is a five-star facility always safe?
No. A high rating lowers the odds of problems, but it is based on past data. Always verify with a visit and the latest inspection report.
How often are nursing homes inspected?
Standard health surveys occur at intervals that average about once a year, with additional complaint and focused infection control surveys. Serious complaints can trigger visits at any time.
Can I see the full inspection report?
Yes. Reports are available through Care Compare, your state survey agency and by request at the facility, which must keep the latest survey results available for residents and visitors.
What if I find a serious citation at the facility I like?
Read it closely, see whether it has been corrected and ask the administrator what changed. Consider whether the problem relates to your relative's needs.
Sources
- Medicare.gov Care Compare — star ratings, inspection reports, fines and staffing
- Centers for Medicare & Medicaid Services — nursing home quality initiative and rating methodology
- National Long-Term Care Ombudsman Resource Center — local ombudsman contacts
