The Five-Star Quality Rating System is a tool to help consumers select and compare skilled nursing care centers. Created by the Centers for Medicare & Medicaid Services (CMS) in 2008, the system assigns ratings based on three key components: Health Care Surveys (both standard and complaint), Quality Measures, and Staffing. Ratings are publicly available through CMS’s Care Compare website and are intended to provide a snapshot of a center’s performance across these areas.
Over time, the Five-Star Rating System has expanded beyond consumer use. Non-consumers, such as state regulators, health care insurers, lenders, and investors use Five-Star to inform decisions related to incentive payments, referral networks, and financial loans.
While the Five-Star Quality Rating System can be a helpful resource, consumers should not rely solely on online ratings when selecting a long term care center for themselves or a loved one. Five-Star should be viewed as one tool among many when assessing a facility, alongside other factors such as personal visits, conversations with staff and residents, specialized services, and individual care needs.
UNDERSTANDING FIVE-STAR COMPONENTS
- Health Inspections: The Health Inspection rating is based on outcomes from state health inspections. Ratings reflect findings from recent annual inspections, complaint investigations, and infection control surveys. Deficiencies are weighted by their scope and severity, and ratings also consider how quickly issues are corrected following inspections.
- Staffing: The Staffing rating includes 6 measures based on nursing home staffing levels and staff turnover. Ratings are based on nursing staffing hours per resident and turnover rates for nursing staff and administrators. Data is collected through the Payroll-Based Journal (PBJ) system and adjusted to account for resident care needs and case mix using the Minimum Data Set (MDS).
- Quality Measures: The Quality Measures rating includes 15 measures based on resident care outcomes and performance data. Ratings are calculated using selected short-stay and long-stay quality measures reported on Care Compare, including data from MDS assessments and claims-based measures. Separate ratings are provided for short-stay and long-stay measures, in addition to an overall quality measure rating.