Fact sheet

CMS’ Five Star Quality Rating System for Nursing Homes

CMS’ Five Star Quality Rating System for Nursing Homes

CMS’ Five Star Quality Rating System for Nursing Homes is a consumer service that offers useful information to the public about the quality of care in the 15,800 nursing homes that participate in the Medicare or Medicaid programs. Users may sort through nursing homes in their area through an online tool at CMS’ Nursing Home Compare website (

Before CMS began these ratings, information about nursing homes was not easily available or understandable to consumers or the public. Families had little access to information where they could gain an understanding of meaningful differences between nursing homes in their area to help them make the right decisions for their loved ones. 

Characteristics of the Rating System

The Five Star Quality Rating System for Nursing Homes offers the most comprehensive overview of nursing home quality in the U.S. based on data from:

  • Onsite Inspections:  180,000 onsite inspections of nursing homes over the most recent 3 years, by trained, objective surveyors from State public health departments and CMS. 
  • Quality Measures (QMs):  Some quality measures that rate each home compared to fixed benchmarks (e.g., prevalence of pressure ulcers, use of restraints, injurious falls). 
  • Staffing Levels:  Self-reported data from the nursing homes on their level of staffing.

The Nursing Home Compare website allows users to make meaningful distinctions among nursing homes regarding the quality of care compared with other nursing homes in the same State.  It is also: 

  • The most comprehensive overview of nursing home quality in the U.S.
  • Accessed by approximately 115,000 visitors each month, about 1.4 million each year.
  • Used by families, nursing homes, hospital discharge planners, researchers, news media, and the public.

Despite some limitations, the Five Star ratings and website are considered useful by advocacy groups and families. 

  • Based on surveys of users completed in March 2013, 85% of consumers report they find the information they are looking for.
  • Nursing Home Compare is the most highly-rated Compare website of all the CMS compare websites.
  • It is an important starting point to compare the quality of different nursing homes in a particular area.

Further Improvements are Underway

CMS is implementing further improvements to the Five Star system beginning in 2015, including:

  • Upgraded user interface to ease navigation and improve the clarity of key metrics for both online and printable formats.
  • Revised scoring methodology by which we calculate each facility’s quality measure rating, which is used to calculate the overall Five Star rating.  Please note that sources independent of self-reporting by nursing homes already are weighted higher than self-reported components in the scoring methodology.
  • Increased number and type of quality measures that are not solely based on self-reported data.  This makes the rating system less susceptible to the manipulation of a few measures, and provides a more comprehensive assessment of the quality of care provided by nursing homes.
  • Improved linkage to state-based websites for improved access to information that is uniquely reported by individual states.
  • Improved reporting on nursing home staffing that increases the accuracy of data for staffing levels, and adds other critical measures such as turnover and retention.