How to read Medicare nursing home star ratings
Understand the overall, inspection, staffing and quality-measure ratings, and keep them separate from family reviews.
By Nana’s List. Updated September 25, 2026. 4 minute read.
Four ratings, different questions
CMS publishes an overall rating and separate ratings for health inspections, staffing and quality measures. Each uses a five-star scale. The overall rating follows CMS rules; it is not a simple average of the three categories or a score from family reviews.
Look underneath the overall score
Health inspections summarize survey findings. Staffing reflects staffing and turnover measures. Quality measures describe selected aspects of resident care. Read the underlying information and its reporting dates before comparing homes. CMS changes its methodology over time, so check the current official explanation.
A missing rating is not zero stars
Some homes do not have a displayed rating. Treat that as missing information and check the facility’s current Medicare profile. These ratings concern nursing homes in the CMS program; they are not a national assisted-living rating system.
Use ratings to prepare better questions
Pick two or three things to discuss on a tour. If the staffing score differs from the overall score, ask the administrator to explain it. Ask what has changed since the reporting period and request specific examples. A rating alone cannot tell you whether a home fits a person’s preferences or current care needs.
Keep every source in its own lane
On Nana’s List, the Medicare score and family reviews are separate. Do not compare a Medicare five-star rating directly with a five-star Google or family review. Open the source link, confirm the facility name and address, and look at the date. A directory entry does not confirm an available bed, a quoted price or eligibility for coverage.