Five Star Rating System for Nursing Homes

The Five-Star Quality Rating System by Health and Human Services 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:

Health Inspections
Staffing
Quality Measures

We provide a star rating for each of these three sources, in case some areas are more important to you than others. Then, these three ratings are combined to calculate an overall rating.

Why is This Important?

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

One of the most important things to do is to visit the nursing homes you are considering. If possible, also contact your Long-Term Care Ombudsman or State Survey Agency before making a decision. Take a copy of the Nursing Home Checklist when you visit a nursing home and talk to the nursing home staff about the information on this website.

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	Strengths	Limits
	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.
STAFFING	Strengths	Limits
	Overall Staffing: The quality ratings look at the ratio of staff to residents plus how many 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 staff requirements.	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	Strengths	Limits
	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 & 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. Not Adjusted for the Population: The quality measures are not adjusted for any special characteristics that residents of a particular nursing home may have, compared to most other nursing homes. More specialized nursing homes may look better or worse with respect to any particular quality measure, depending on how different the population is compared to the residents in other nursing homes.
	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.

NOTE: 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.