Nursing Home Star Ratings: What the Five Stars Mean

Medicare defines the official meaning at both ends of the scale. Five stars mark a home as much above average in quality. One star marks it as much below average.

Getting one star is fairly common. The October 2026 Care Compare files show 2,982 of the 14,690 homes rated one star overall.

Every home receives a single overall rating, plus three separate ratings covering the areas that feed into it:

• Health inspections
• Staffing
• Quality measures

A home might do well in one area and badly in another. Checking all three tells you more than the overall stars do on their own.

Each nursing home gets a health and safety visit from state inspectors about once a year. A home may face more frequent inspections if it performs poorly, or after complaints or incidents it has reported. During a visit, inspectors look at residents' medical records and speak with residents, family members, caregivers, and staff.

If a home falls short of a federal standard, inspectors write a citation, meaning a formal record of the problem. Each citation carries points that reflect how serious and how widespread the issue is. When a problem found at an earlier inspection still is not fixed, extra points get added.

The rating draws on the two most recent yearly inspections, along with complaint and infection control inspections from the past 36 months. The more recent yearly inspection weighs heavier.

Inspections for fire and building safety do not count toward the star rating.

Care Compare flags certain homes with an abuse icon, a red symbol for homes with recent abuse findings. These homes are capped at no more than two stars on health inspections. The October 2026 files show 1,429 homes with this icon.

Homes can push back on a citation through an informal dispute, asking the state to take another look at the finding. Care Compare now posts these publicly. While a dispute is still open, the citation stays out of the star rating, so the stars may not yet capture every problem in a home's history.

The staffing score rests on six measures. Three track the nursing hours each resident receives daily, and three track how often staff leave. Someone counts as having left after 90 straight days with no shifts. Turnover and weekend staffing started counting toward the stars in July 2022.

National averages give you a benchmark for judging any single home.

These figures are drawn from the October 2026 Care Compare files.

When it comes to quality measures, Medicare checks how homes document schizophrenia in resident records. Homes with inaccurate records see their quality measure ratings changed.

Medicare itself acknowledges that no rating system can cover everything that counts when picking a home. The stars say nothing about how much specialty care, like rehabilitation or dementia care, a home offers. Medicare suggests pairing the stars with an in-person visit and input from sources like your State Ombudsman program.