Caregiver Support14 mins
Nursing home guide
How to read nursing home ratings.
CMS rates Medicare- and Medicaid-certified nursing homes from 1 to 5 stars. Here is what goes into those stars, what inspections, penalties and staffing numbers tell you, and how to use them to choose, with figures from all 14,700-plus nursing homes we profile.
- nursing homes in CMS’s files
- 14,733
- of rated homes have 5 stars ("much above average")
- 20%
- had a fine or payment denial in the last three years
- 46%
- average nurse hours per resident per day
- 3.86
CMS Provider Information, August 2026. Star shares count only rated nursing homes.
01Star ratings
What the stars mean
CMS gives every rated nursing home an overall rating and three domain ratings. The overall rating isn't an average: it starts from the inspection rating and moves up or down for staffing and quality.
- Step 1
Start with health inspections
Findings from the two most recent annual inspections, plus three years of complaint and infection-control inspections, weighted by how serious and widespread each problem was.
- Step 2
Adjust for staffing
One star added for a 5-star staffing rating, one taken away for 1 star. Staffing combines nurse hours, adjusted for how sick residents are, with staff turnover, all from payroll data.
- Step 3
Adjust for quality measures
One star added for a 5-star quality rating, one taken away for 1 star. The rating uses 15 measures from resident assessments and Medicare claims.
- Result
Overall rating, 1 to 5 stars
A nursing home with a 1-star inspection rating can rise by one star at most, because CMS weights what inspectors found on site most heavily.
How the ratings are spread
Nursing homes are spread almost evenly across the five levels: about one in five sits at each. One reason is that CMS grades inspections on a curve within each state: the top 10% of a state's nursing homes get 5 inspection stars and the bottom 20% get 1.1
So a 5-star rating means "much above average" for the state, not a guarantee. Look at the domain ratings too: a 4-star overall rating can hide a 1- or 2-star inspection rating.
Each profile lists CMS's quality measures for short-stay residents (rehab after a hospital stay) and long-stay residents separately, with the period each measure covers, and marks the measures that count toward the quality measure star.
128 nursing homes have no overall rating, usually because they are new or in CMS's Special Focus program.
02Inspections
What inspectors find
State inspectors visit every nursing home at least every 15 months, and a state's average gap must be 12 months or less. They also investigate complaints in between.
Each problem inspectors find is a citation (also called a deficiency), tagged with a federal requirement number, the F-tag, and a letter for how serious and how widespread it was.3
The letters matter more than the count. One citation at level G or above means a resident was actually harmed; several at level D may be lesser problems found across a home.
Each profile shows how many health deficiencies were cited in the last three inspection cycles and lists the most recent citations; the report card lists every one.
Two flags on a profile deserve attention: CMS's abuse icon, now on 1,436 nursing homes (10%), and the Special Focus Facility program for persistently poor performers, which has 84 members and 447 candidates.
How serious was it?
- J–LImmediate jeopardyResidents faced, or were likely to face, serious injury, harm or death.
- G–IActual harmAt least one resident was harmed, short of immediate jeopardy.
- D–FPotential for more than minimal harmNo one was hurt, but residents were at risk of more than minimal harm.
- A–CPotential for minimal harmProblems with little risk to residents.
03Penalties
What penalties tell you
When inspectors find a nursing home out of compliance, CMS can fine it or stop paying for new admissions. Fines don't require harm: any citation at level D or above can bring one, though the highest daily fines are for immediate jeopardy.
Civil money penalties are fines, charged per day until a problem is fixed or per instance. In 2026, daily fines run from 36 to ,211 below immediate jeopardy and from ,351 to 7,378 at immediate jeopardy; a single-instance fine runs from ,739 to 7,378.5
Denial of payment for new admissions means Medicare and Medicaid stop paying for newly admitted residents until the home is back in compliance. CMS must impose it when a home stays out of compliance for three months.
CMS's penalty data covers about the last three years, and recent fines can take months to appear. It also doesn't say whether a fine was charged per day or per instance, so a fine is not a count of harm.
Read the dates and the pattern. One fine several years ago tells a different story than several in the past year, especially if the citations behind them repeat.
- had at least one fine or payment denial in CMS's three-year window
- 46%
- median fines per fined nursing home over three years
- $33,834
6,795 of 14,733 nursing homes; $459.1 million in fines in total; 1,897 with a payment denial. CMS Provider Information, August 2026.
04Staffing
Staffing, in numbers
Staffing is hard to judge on a tour, and it's in CMS's data. Nurse hours come from payroll records nursing homes submit each quarter.
- nurse hours per resident per day, on average
- 3.86
- of those from registered nurses
- 0.69
- nurse hours per resident per day on weekends
- 3.42
- average yearly registered nurse turnover
- 43%
Averages across nursing homes that report each measure. CMS Provider Information, August 2026.
CMS's staffing rating adjusts nurse hours for how sick residents are, and it counts weekend staffing and staff turnover.1 Turnover matters: nursing homes where more staff leave each year tend to score lower on CMS quality measures and star ratings.8
A federal rule in 2024 would have required at least 3.48 nurse hours per resident per day, including 0.55 from registered nurses; it was repealed before any hour minimum took effect. In CMS's August 2026 data, 64% of nursing homes that reported hours met the total, and 22% met all three of its hour floors.9
05Ownership
Who owns the nursing home
Most nursing homes are run for profit, and most belong to a chain. Ownership doesn't decide quality on its own, but it's worth knowing who is accountable.
Research has found differences on average: a 2009 review of 82 studies found non-profit nursing homes had more or better staffing and fewer pressure ulcers than for-profits, while differences in inspection deficiencies weren't statistically significant. Individual homes vary.7
69% of nursing homes belong to a chain CMS identifies. Few disclose a private-equity owner: 0.44% did in the CMS filings behind our 2026 ownership study.9
Every nursing home profile shows the ownership type CMS records (for-profit, non-profit or government, with the legal form) and lists its owners and operators as disclosed to CMS. Size alone doesn't predict quality; compare staffing hours to how many residents a home cares for.
06How to choose
How to choose a nursing home, step by step
Use the data to build a shortlist, then use your eyes and questions to decide.
Set your area
On the nursing home search, enter a city, state or ZIP code and pick a radius from 10 to 100 miles.
Screen out recent penalties
Turn on Zero Federal Penalties to hide nursing homes with a fine or payment denial in CMS’s three-year window.
Pick an ownership type
Use the Ownership Type filter to show only for-profit, non-profit or government-run nursing homes, or narrow non-profits to faith-based ones. CMS files every nursing home under one of these; the ownership section above explains what the research says.
Filter by stars, then read the parts
Filter by CMS Overall Rating, then open each profile and check the health inspection, staffing and quality measure ratings separately.
Compare side by side
Put up to three nursing homes on Compare and look at the same numbers in one view.
Read the inspection details
Open the report card, and use the F-tag lookup to decode citation numbers.
Visit, then visit again
Go at different times, including an evening or a weekend. Talk with residents and families, and ask to see the latest inspection report.
07FAQ
Questions families ask
Is a 5-star nursing home always better than a 3-star one?
Not always. The overall rating starts from the health inspection rating, and inspection stars are graded against other nursing homes in the same state, so a 3-star home in one state is not held to the same bar as a 3-star home in another. Check the three domain ratings and the recent inspection findings, then visit.
How often are nursing home ratings updated?
CMS refreshes Care Compare each month, and inspection ratings change when a new inspection or complaint finding is added. Staffing and quality measures cover earlier quarters. We check CMS for new nursing home data every day and load each release when it is published.
Why doesn’t a nursing home have a star rating?
CMS gives no ratings to a nursing home with only one standard inspection on record, usually because it is new, or to a home in the Special Focus Facility program for persistently poor performers.
What does the abuse icon mean?
CMS adds it when a nursing home was cited for abuse that harmed a resident on its latest inspection or in the past year, or for abuse that put residents at risk on each of its last two inspection cycles. Its health inspection rating is capped at 2 stars, so its overall rating cannot be above 4.
Does Medicare pay for a nursing home?
Medicare pays for short-term skilled nursing and rehab after a qualifying hospital stay, for up to 100 days. It does not pay for long-term custodial care; Medicaid, long-term care insurance or personal savings usually do. Our skilled nursing guide explains the 100 days.
Where do these numbers come from?
From CMS’s Provider Information file, the same data behind Medicare’s Care Compare, as of August 2026. Our methodology explains every source and how often it updates.
08Sources
Where this guide comes from
Every rule and figure on this page, with a link to the original.
Written by the Care Ratings Team and reviewed by the TCR Editorial Team. Last reviewed . How our data works: methodology.
This guide is general information, not medical, legal or financial advice. Coverage rules change; check Medicare.gov or call 1‑800‑MEDICARE (1‑800‑633‑4227) about your own situation.
Next step
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