5-Star Rating System

In early 2012, the Centers for Medicare & Medicaid Services (CMS) will begin to display new quality
The Five-Star Quality Rating System was created to help consumers, their families, and caregivers compare nursing homes more easily and help identify areas about which you may want to ask questions.

This rating system is based on continued efforts as a result of the Omnibus Reconciliation Act of 1987 (OBRA '87), a nursing home reform law, and more recent quality improvement campaigns such as the Advancing Excellence in America's Nursing Homes, a coalition of consumers, health care providers, and nursing home professionals.

Nursing home ratings are taken from the following three sources of data:

1. Health Inspections
2. Staffing
3. Quality Measures

Why is this important?

Nursing homes vary in the quality of care and services they provide to their residents.
Reviewing (1) health inspection results, (2) staffing data, and (3) quality measures are three important ways to measure nursing home quality. This information gives you a "snap shot" of the care individual nursing homes give.

Strengths and Limitations of the Five-Star Ratings

Like any information, the Five-Star rating system has strengths and limits. Here are some things to consider as you compare nursing homes.

Health Inspection Results


Comprehensive: The nursing home health inspection process looks at all major aspects of care in a nursing home (about 180 different items).

Onsite Visits by Trained Inspectors: It is the only source of information that comes from a trained team of objective surveyors who visit each nursing home to check on the quality of care, inspect medical records, and talk with residents about their care.

Federal Quality Checks: Federal surveyors check on the state surveyors' work to make sure they are following the national process and that any differences between states stay within reasonable bounds.


Variation between States: There are some differences in how different states carry out the inspection process, even though the standards are the same across the country.

Medicaid Program Differences: There are also differences in state licensing requirements that affect quality, and in state Medicaid programs that pay for much of the care in nursing homes.

TIP: The best comparisons are made by looking at nursing homes within the same state. You should be careful if you are trying to compare a nursing home in one state with a nursing home in another state.



Overall Staffing: The quality ratings look at the overall number of staff compared to the number of residents and how many of the staff are trained nurses.

Adjusted for the Population: The ratings consider differences in how sick the nursing home residents are in each nursing home, since that will make a difference in how many staff are needed.


Self-Reported: The staffing data are self-reported by the nursing home, rather than collected and reported by an independent agency.

Snap-Shot in Time: Staffing data are reported just once a year and reflect staffing over a 2 week period of time.

TIP: Quality is generally better in nursing homes that have more staff who work directly with residents. It is important to ask nursing homes about their staff levels, the qualifications of their staff, and the rate at which staff leave and are replaced.

Quality Measures


In-Depth Look: The quality measures provide an important in-depth look at how well each nursing home performs on ten important aspects of care. For example, these measures show how well the nursing home helps people keep their ability to dress and eat, or how well the nursing home prevents and treats skin ulcers.

National Measures: The ten quality measures we use in the Five-Star rating are used in all nursing homes.


Self-Reported Data: The quality measures are self-reported by the nursing home, rather than collected and reported by an independent agency.

Just a Few Aspects of Care:
 The quality measures represent only a few of the many aspects of care that may be important to you.

TIP: Talk to the nursing home staff about these quality measures and ask what else they are doing to improve the care they give their residents. Think about the things that are most important to you and ask about them, especially if there are no quality measures that focus on your main concerns.

Use the Five-Star together with other information

The Five Star Quality Rating System is not a substitute for visiting the nursing home. This system can give you important information, help you compare nursing homes by topics you consider most important, and help you think of questions to ask when you visit the nursing home.

Use the Five-Star ratings together with other sources of information. Choosing a nursing home that's near family and friends can be very important to your quality of life in the nursing home. Having family and friends nearby allows for more frequent visits and opportunities for outings. Family members and friends can also talk to the nursing home staff about your care needs, preferences, and gaps in care. Therefore, you may wish to start your search by considering how close you want to be to family and friends, and then use the rating system to compare nursing homes in the area you are considering.


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