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5 stars

Understanding the Nursing Home Five-Star Rating System and how you can choose the right nursing home

Published on Oct 20, 2017

History of the 5 Star Rating – Washing Machines and Nursing Homes

While the Centers for Medicare and Medicaid Services (CMS) launched Nursing Home Compare in 1998, it wasn’t until 2009 that the familiar one-to-five star ratings, like way that movies, hotels and restaurants are often measured, was applied.

This came about after Senator Ron Wyden (D) of Oregon complained that it was easier to find consumer information on washing machines than skilled nursing facilities. So, the Five-Star Rating system was made as a tool to help consumers select and compare skilled nursing centers from three main categories; a center’s annual health inspection survey, quality measures and staffing ratios.    

A star rating is provided for these three categories and those ratings are combined to calculate an overall rating.

There are many technical measurements, including long-term stay versus short-term care to home, and other directives to the system, but the following three aspects largely make-up what provides a center’s star rating.

Annual Health Inspection Surveys:

Skilled nursing facilities (SNFs) are inspected annually by state agencies to ensure they meet all state and federal requirements. Items that do meet requirements are labelled as a “citation” or “tag.”

Quality Measures:
The rating for the Quality Measurement has information on 11 different physical and clinical measurements for nursing home residents, as well as information about the SNFs use of antipsychotic medications in both long-term and short-term residents. There are more than 12 million assessments of the conditions of nursing home residents are used in the Five-Star Rating system.


The staffing rating has information about the number of hours of care provided in average to each resident each day by nursing employees, and does take into consideration difference’s in the levels of care for each resident.

Measurements the Five-Star Rating System misses

While CMS Five Star Rating Home Quality Rating System considers the results of a center’s annual state survey, staffing levels and quality care measures, it doesn’t consider resident and customer satisfaction levels.

“Also, this information should always be used along with factors such as visiting the facility and meeting the employees, and even convenience to visiting with your loved one at the center,” said Carla Peters, Clinical Liaison for American Medical Facilities Management (AMFM).

It is important to keep patients near the community they know. In many instances, their church and older friends can easily travel to and visit. 

“Every person and every situation is different, and along the star ratings, customer service, online reviews, and visiting a center should be taken together to choose the right care center for your family,” Peters said.

There are some changes coming to the rating system in 2018. There will be a temporary freeze of the Health Inspection Five-Star rating that will last for 12 months. Additionally, the Health Inspection Star Rating will use a 2-year cycle.

Finally, a summary of a center’s most recent survey will be included on the Nursing Home Compare website beginning in 2018.