Guide
Medicare star ratings for nursing homes: how to read them
Updated October 15, 2026 · Reviewed against official sources
On every nursing home listing in our directory, we show the Medicare star ratings, the abuse icon, and whether the place is in the Special Focus Facility program. This guide explains what each piece of information means, what it doesn't tell you, and how to talk about it with the facility.
What is Care Compare?
Care Compare is Medicare's official tool for comparing health care providers. It includes nursing homes that are certified by Medicare or Medicaid. CMS, the federal agency that runs Medicare and Medicaid, updates the data once a month.
Important: assisted living doesn't have Medicare star ratings. There's no federal rating for assisted living or for board and care. If you see "stars" for an assisted living community, they come from another source, such as online reviews. For those places, the official information is with the state agency that issues the licenses. See what is assisted living.
The three parts of the rating
| Part | What it measures | Where the data comes from |
|---|---|---|
| Health inspections | Deficiencies (failures to follow the rules) found by state inspectors | The two most recent standard inspections and complaint inspections |
| Staffing | Nursing hours per resident and staff turnover | Payroll data the facility reports every quarter |
| Quality measures | Residents' health outcomes, such as falls, pressure ulcers, or rehospitalizations | Resident assessments and Medicare claims |
Health inspections
This is the part that carries the most weight. Inspectors from the state agency visit the facility without notice, usually every 12 to 15 months, and also when they get a complaint. Since July 2025, CMS uses the two most recent standard inspections: the latest one counts for 3/4 and the one before it for 1/4. Each deficiency counts based on how serious it is and how many residents it could affect.
This rating is compared within the same state. The top 10% in each state get 5 stars, and the bottom 20% get 1 star. That's why 3 stars in one state don't mean exactly the same thing as 3 stars in another.
Staffing
It measures how many hours of nursing care each resident gets per day, adjusted for how much care the residents at that facility need. It also counts registered nurse (RN) hours, weekend staffing, and turnover: how many nurses and administrators leave their jobs. Low turnover usually means your loved one will see familiar faces, and that the staff knows their habits well.
Behind this number are people: nursing assistants (CNAs), nurses, and cooks who do demanding work every day. During your visit, ask how long the team has been there and how the facility supports them.
Quality measures
This part uses data from long stays (permanent residents) and short stays (rehab after a hospital stay). If your loved one is going for a few weeks of therapy, look at the short-stay measures. If they're going to live there, look at the long-stay ones.
How the overall rating is calculated
- It starts with the health inspection stars.
- It adds 1 star if staffing has 5 stars, or subtracts 1 if staffing has 1 star.
- It adds 1 star if quality measures have 5 stars, or subtracts 1 if they have 1 star.
The result always stays between 1 and 5. If inspections have 1 star, the overall rating can only go up by 1 star at most. CMS explains it this way: in-person visits by inspectors should count more than reported data.
The abuse icon
It's a red hand inside a circle. According to CMS's technical guide, it appears when the facility had:
- an abuse-related citation where there was actual harm to a resident, on the most recent standard inspection or on a complaint inspection in the last 12 months, or
- abuse-related citations with potential harm in both the most recent period and the one before it.
For CMS, "abuse" in this calculation covers several rules: protecting residents from mistreatment and neglect, from misuse of their belongings or money, and from being isolated or confined without reason. If a facility has the icon, its inspection rating is capped at 2 stars, and its overall rating can't go above 4. The icon is removed in the first monthly update after the facility no longer meets those criteria. In September 2026, 1,429 facilities nationwide had the icon.
The icon is something to talk about, not a conclusion. Read the inspection report to understand what happened, when, and how many people it affected, and ask the administrator what they've changed since then: training, supervision, new staff. Many facilities can explain it clearly and show their plan of correction.
Special Focus Facility (SFF)
It's a CMS program for nursing homes whose inspection results have been below what's expected for about 3 years. Its goal is to help them improve with closer follow-up. These facilities:
- are inspected every 6 months,
- face increasingly strict penalties if they don't improve,
- don't show star ratings on Care Compare while they're in the program; they show a notice instead.
There are also SFF candidates: facilities with a similar history that haven't entered the program yet. In September 2026, there were 87 SFF facilities and 440 candidates, out of 14,690 nationwide. A facility "graduates" when it passes two standard inspections in a row with few deficiencies and none that are serious. If a facility you're interested in is in the program, ask what stage it's in and what results it had on its last inspection.
The high-performance trophy (new in 2026)
Since October 8, 2026, Care Compare shows a trophy icon, High Performing Facility. It means the facility meets strict requirements (a 5-star overall rating, good staffing levels, and no recent serious harm, among others) to get a shorter inspection. It's good recognition of the team's work, but it isn't permanent: the facility loses it if it stops meeting the criteria.
What the stars don't tell you
Star ratings are a good first filter, but they have limits:
- They don't measure how kindly people are treated or whether the staff speaks Spanish. You'll find that out by visiting. See our guide to finding staff who speak Spanish.
- The data runs behind. An inspection can be more than a year old. If the facility recently changed owners or administrators, things may be different now, for better or for worse.
- Staffing is reported by the facility itself, although CMS does audits.
- They don't include the price or whether beds are available.
- There's currently no federal minimum for nursing hours. The 2024 rule that set one was struck down and repealed. Some states have their own minimums.
How to use the star ratings, step by step
- Make a short list with our search tool or with places near you.
- Compare 2 or 3 options side by side with our compare tool. Look at inspections, staffing, and quality separately, not just the overall rating.
- If a facility has the abuse icon or is in the SFF program, read the full report and write down your questions for the visit.
- Read the inspection report for each option. Look at how serious the problems are and whether the same issue keeps coming up.
- Visit at different times of day with our visit checklist and ask what has changed since the last inspection.
For the full process, read how to choose a nursing home and the most common mistakes when choosing. If your loved one already lives in a facility and you'd like to talk about something in their care, see resident rights and complaints.
Frequently asked questions
Is a nursing home with 2 stars a bad choice?
Not necessarily. Stars are compared within the state and may reflect an inspection from more than a year ago. Read the report, ask what has changed, and visit. A facility with fewer stars may be the best choice for your loved one because of location, language, or the way people are treated.
How often do the star ratings change?
CMS updates Care Compare every month. The inspection part changes when there's a new inspection or a complaint with deficiencies; staffing and quality change when new quarterly data comes in.
Where can I see the full inspection report?
On Care Compare, on the facility's page, in the inspections section. Some states have their own search tools with more detail. Also, federal law requires the facility to post the results of its most recent inspection where people can see them, and to show anyone who asks the reports from the last 3 years and its plan of correction. Asking for them is perfectly normal.
Are there star ratings for assisted living or adult day centers?
No. Medicare star ratings are only for certified nursing homes. For other types of care, check with your state's licensing agency.
Inspection rules may vary by state. This guide is for information only and doesn't replace reviewing the official reports.
Sources
- CMS, Five-Star Quality Rating System: https://www.cms.gov/medicare/health-safety-standards/certification-compliance/five-star-quality-rating-system (accessed October 15, 2026)
- CMS, Five-Star Quality Rating System Technical Users' Guide, September 2026: https://www.cms.gov/medicare/provider-enrollment-and-certification/certificationandcomplianc/downloads/usersguide.pdf (accessed October 15, 2026)
- Medicare.gov, Care Compare: https://www.medicare.gov/care-compare/ (accessed October 15, 2026)
- Medicare.gov, Special Focus Facilities: https://www.medicare.gov/care-compare/resources/nursing-home/special-focus-facilities (accessed October 15, 2026)
- CMS, SFF and SFF candidate list, September 2026: https://www.cms.gov/files/document/sff-posting-candidate-list-september-2026.pdf (accessed October 15, 2026)
- CMS, QSO-26-14-NH (revised): https://www.cms.gov/files/document/qso-26-14-nh-revised-2026-09-29.pdf (accessed October 15, 2026)
- CMS Provider Data Catalog, Provider Information: https://data.cms.gov/provider-data/dataset/4pq5-n9py (accessed October 15, 2026)
- eCFR, 42 CFR 483.10 (resident rights, including access to inspection results): https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-483/subpart-B/section-483.10 (accessed October 15, 2026)
- Federal Register, CMS-3442-IFC: https://www.govinfo.gov/content/pkg/FR-2025-12-03/html/2025-21792.htm (accessed October 15, 2026)
This is general information, not medical, legal or financial advice. Rules vary by state and by year: confirm with the official agency that applies to you.
Keep reading
Choosing a place for care
How to choose a nursing home: assess the need, check the license, star ratings and inspections, visit, what to ask and how to read the contract.
Rights and complaints
Federal nursing home resident rights, how to resolve concerns with the staff, what the ombudsman does and how to file a formal complaint.
Types of senior care
Nursing homes, assisted living, board and care, memory care, adult day care, home care, and hospice: who each one is for, what it costs, and who pays.
How to choose senior living without rushing: 5 practical tips
Take time to compare, look at daily care, read inspections in context, plan how to pay and review the contract: five tips to help you choose well.
