How to read Medicare star ratings, inspection reports, and quality measures—and what they really tell you about a nursing home.
What Are Star Ratings?
Medicare rates every nursing home from 1 to 5 stars. 5 stars is the best, 1 star is the worst. These ratings are based on health inspections, staffing levels, and quality measures.
Where to Find Them
Go to Medicare.gov/care-compare and search for nursing homes in your area. You'll see the overall star rating plus ratings for health inspections, staffing, and quality measures.
Stars Aren't Everything
A 5-star facility isn't automatically perfect, and a 3-star facility isn't necessarily bad. Use the ratings as a starting point, but visit in person and trust your gut.
How It's Calculated
The overall rating combines three separate ratings: health inspections (most important), staffing levels, and quality measures. Health inspections count the most.
What to Look For
Aim for 3+ stars overall. Anything below 3 stars should raise concerns. 5 stars is ideal, but a good 4-star facility is fine too.
Don't Ignore the Details
Two facilities might both have 3 stars overall, but one could have serious health violations while the other just has lower staffing. Dig into the details.
This Is the Most Important Rating
Health inspections measure how well the facility follows health and safety rules. Inspectors check for things like medication errors, cleanliness, resident safety, and quality of care.
What Inspectors Look For
They review medical records, interview residents and families, observe care being provided, and check the facility for safety hazards. Inspections happen at least once a year, sometimes more if there are complaints.
Read the Inspection Report
Don't just look at the star rating—read the actual inspection report. It lists every violation (called "deficiencies"). See what problems they found and whether they were corrected.
What's a Red Flag?
Serious violations include abuse, neglect, medication errors, infections, bedsores, falls, or unsafe conditions. One or two minor violations are normal, but repeated serious issues are dealbreakers.
Why Staffing Matters
More staff means better care. If there aren't enough nurses and aides, residents wait longer for help, don't get bathed regularly, and miss medications.
What Medicare Measures
Medicare looks at how many hours of care each resident gets per day from RNs (registered nurses), LPNs (licensed practical nurses), and CNAs (nursing assistants).
What's a Good Number?
Look for at least 4+ total nursing hours per resident per day. Higher is better. Also check RN hours specifically—facilities should have RN coverage 24/7.
Weekend and Night Shifts
Ask about staffing on weekends and nights. Some facilities cut staff when administrators aren't around. That's when problems happen.
What This Measures
Quality measures track specific health outcomes—things like how many residents get pressure sores, lose too much weight, get infections, or are able to move around independently.
Long-Stay vs. Short-Stay
Medicare separates data for long-term residents vs. short-term rehab patients. If you're looking for long-term care, focus on the long-stay measures.
Key Things to Check
Look at rates for pressure sores (bedsores), falls with injury, catheter use, antipsychotic medication use, and mobility decline. Lower is better for most of these.
Context Matters
Some facilities care for sicker, more complex residents, which can make their numbers look worse. Compare similar facilities (like skilled nursing vs. rehab-focused).
Check Recent Complaints
Medicare Care Compare shows complaints filed against the facility. Look for patterns—one complaint isn't a big deal, but multiple complaints about the same issue is a red flag.
Look at Violations
Violations are categorized by severity: "no harm," "potential for harm," "actual harm," and "immediate jeopardy" (life-threatening). Immediate jeopardy violations are serious—avoid facilities with recent ones.
Were Issues Fixed?
Check if the facility corrected the problems. If they're repeating the same violations year after year, they don't care about fixing them.
Self-Reported Data
Some data (like staffing hours) is self-reported by the facility. They might fudge the numbers. That's why visiting in person is so important.
Ratings Can Be Outdated
Medicare updates ratings quarterly, but a lot can change in 3 months. A facility could have new management, new staff, or new problems that don't show up yet.
Good Ratings Don't Guarantee a Good Experience
A 5-star facility can still have rude staff, bad food, or an environment that doesn't fit your needs. Numbers don't tell the whole story.
Trust Your Instincts
If you tour a 5-star facility and it feels off, don't ignore that. If a 3-star place feels warm and caring, that matters too. Data is helpful, but it's not everything.
1. Start with Medicare Care Compare
Look up nursing homes in your area. Filter by star rating (3+), check inspection reports, and make a list of facilities worth visiting.
2. Read Inspection Reports
Don't skip this step. Skim through the violations. Are they minor paperwork issues or serious care problems? Are they fixed?
3. Visit in Person
Tour at least 3-5 facilities. Talk to staff and residents. See if the place matches what the data says.
4. Compare Your Options
Make a spreadsheet. List ratings, your observations, costs, location, and gut feeling. This helps you see which facility is the best fit.
5. Keep Monitoring
After your loved one moves in, check the ratings every few months. If they drop significantly, ask why.
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