Compare Nursing Homes Side by Side

CMS, the federal agency in charge of Medicare, built the Five-Star Quality Rating System so families could size up nursing homes more easily. On the Care Compare website, every home receives somewhere between one and five stars.

A home with five stars is viewed as much above average in quality, while one star means much below average. Right now, the federal file lists 14,690 nursing homes, and 2,982 of them sit at one star overall.

Along with its single overall rating, each home gets three separate scores covering health inspections, staffing, and quality measures. A facility might score well in one area and badly in another, which is why reading all three ratings next to each other is worthwhile.

Staff turnover and weekend staffing have factored into the star ratings since July 2022. Turnover describes how often nursing staff leave and new ones must be hired.

Each nursing home gets a health and safety check from state inspectors about once a year. Homes with weak performance, or with complaints or self-reported incidents, may be inspected more often.

During a visit, inspectors go through residents' medical records. They also speak with residents, relatives, caregivers, and office staff. Among the standards they review is whether the facility has enough quality staff to deliver adequate care.

A citation is issued whenever inspectors determine a home falls short of a federal standard. It is a written record of one specific problem. Each citation receives points based on how serious and widespread the problem is, and these points are used to calculate the health inspection rating. When a problem spotted in a past inspection still has not been fixed, extra points are added on top.

The rating also reflects the last three years of inspections tied to complaints, incidents, and infection control. If a home is disputing a citation, it doesn't count toward the stars until the dispute is settled. Since January 2023, Care Compare also shows citations a home is informally disputing.

Homes with fewer past citations, more staff and other signs of good care may get a shorter inspection, but it still checks that the home meets health and safety standards.

Most citations did not find residents harmed or in immediate danger. Among the 418,947 health citations now on file, 22,564 involved residents who were harmed or placed in immediate danger. Immediate danger is the gravest level, where a resident's health or safety faced serious risk, and 9,248 citations hit that level.

Certain problems show up over and over nationwide.

If two homes carry a similar citation count, the better question is how many of those citations involved harm. Looking at what inspectors found, not just the number of citations, can help you compare how serious and widespread the problems were.

Fines offer another signal. 6,510 homes have at least one fine, and together those fines total $454,984,026.

Some things fall outside what the ratings measure. They do not tell you how much specialty care a home delivers, like rehabilitation or dementia care.

Location counts as well. Residents benefit from family visits, so picking a home close by can beat picking a higher-rated one that is far away.

CMS recommends pairing the ratings with other information, and that includes visiting each home yourself. Advocacy groups near you and the State Ombudsman program can also shed light on a home's care.