How Medicare rates a nursing home
Medicare gives every nursing home a star rating. It is useful, it is free, and it is misunderstood in four specific ways that this page explains. None of this is our opinion. It is how the rating is built.
On this page
The rating is a rank, not a score
This is the single most important thing on this page, and almost nobody knows it.
Inspections are graded on a curve, inside each state
Inspectors add up points for what they find, and the more points a home has, the worse it did. Medicare then sorts every home in the state by that score and hands out stars by rank: roughly the top tenth get five, the bottom fifth get one. So a star measures how a home compares to its neighbors, not how safe it is.
What that means in practice
In Alabama, the worst score that still earned five stars was 3 points. In New Mexico it was 61. A home with an identical record can be a five-star home in one state and a three-star home in another. Every rating on this site says which state it is relative to.
The overall star is three ratings blended
Health inspections, staffing, and quality measures. Inspections drive it. Staffing and quality can each move it up or down by one star, but a home cannot reach five overall without a strong inspection record, and cannot be lifted more than one star by them.
Ten of the fifteen quality measures come from data the home reports itself
Homes report the clinical data behind that third rating themselves. Inspection findings are recorded by a state surveyor who visited. We lean on the findings.
What inspectors write down
A surveyor visits roughly once a year, unannounced, and again whenever somebody complains. Everything they find becomes a tagged finding with a severity letter. There are 419,479 of them on this site across 267 kinds of violations.
The most serious thing an inspector can record. It means a resident was in danger of serious injury, harm, impairment or death at the time of the visit. It is rare and it is not a paperwork problem.
A resident was harmed. Not endangered, harmed. One step below immediate jeopardy and still serious.
Something was wrong that could have hurt someone but had not yet. This is the biggest category by far, and it covers everything from a propped fire door to a missed care plan review.
Minor and usually administrative.
A count of findings is a count of tags, not of separate incidents. One bad visit can produce several tags. We show you the dates so you can see whether a home has one bad inspection on its record or a pattern across years.
Whether a problem was fixed
This one is easy to get wrong, and getting it wrong means publishing a false statement about a named business.
Medicare does not record "fixed" and "not fixed". It records one of six different statuses, and they do not mean the same thing. A home can have a date of correction, a plan of correction with no date yet, no plan at all, a finding that was already corrected before the inspector arrived, a waiver, or a finding that needed no revisit. We print the wording that matches the actual status, every time. We never summarize them into a yes or a no.
We also publish Medicare's own description of each violation next to our plain-English version, so you can see exactly what the government recorded rather than only our summary of it.
Staffing, and what "short on staffing" means here
Nursing hours predict more about a resident's experience than any other number. Nationally, homes average 3.86 hours of nursing care per resident per day, 0.69 of it from a registered nurse, and 46% of nursing staff leave within a year.
Federal law does set some staffing rules. Under 42 CFR 483.35 a home must have licensed nurses on duty 24 hours a day and a registered nurse for at least 8 consecutive hours a day, 7 days a week. What it does not set is how many hours of nursing care each resident should get. CMS wrote that into a rule in 2024; a federal court vacated the rule in April 2025, Public Law 119-21 barred its enforcement until 2034, and it was repealed outright in February 2026. So when this site says a home is short on staffing, it is not saying the home is breaking a law.
Two things. First, a published research benchmark that estimates how much nursing time a home's residents need given how sick they actually are. It is not a Medicare figure: we work it out from the home's own Medicare case-mix score using the CASE formula (Harrington and others, Journal of the American Geriatrics Society, 2025). A home below it is short relative to its own residents, not to an average. Second, the 4.1 total and 0.75 registered nurse hours per resident per day that CMS commissioned research identified in 2001 as the level below which residents are more likely to be harmed. 10,264 of the 14,690 homes on this site report less than 4.1 hours.
Homes file them quarterly from actual payroll records and CMS audits them. They are more reliable than the old self-reported staffing numbers, and they still only describe an average day.
Abuse is counted two different ways
The two official measures differ by a factor of four. Sites that quote one number without saying which are not being straight with you.
Medicare's abuse warning: 1,426 homes
Medicare puts a warning on a home's profile when abuse was cited and a resident was harmed, or when abuse was cited twice in a row. It is narrow, and it comes off after about a year. When this site says a home "carries Medicare's abuse warning", this is what it means.
Abuse findings on the record: 5,765 homes
Separately, inspectors cite homes under three specific tags: failing to protect a resident from abuse, the wrongful use of a resident’s belongings or money, and involuntary seclusion, which means confining someone against their will. Those findings stay on the record for the three inspection cycles we show. This is the wider number, and we count only those three tags.
What we deliberately do not count
Some published "abuse" counts sweep in a broader category that includes things like late paperwork on an investigation. That adds roughly half again as many homes and it is not what a family means by abuse. We leave it out.
A home can be in one list, both, or neither
They measure different things over different windows, so we label them separately on every page rather than merging them into one scary number.
The worst homes in the country have no star rating at all. Rendered carelessly, they look like missing data.
Medicare runs a Special Focus Facility program for homes with a persistent record of serious problems. Most states get a small number of slots, from one to six, scaled to how many nursing homes they have. A few of the smallest places have none on the list and none in line: on the current release that is Alaska, the District of Columbia, Guam and Puerto Rico. 84 homes are on the list right now and 441 more are in line for a slot. Medicare withholds the star rating from every home on the list. Medicare replaces the stars with a warning sign, but many sites that copy the data show only the empty rating, so on those the very worst homes show a blank where the stars should be. This site says "rating withheld" and flags them, every time.
Fines, payment denials and ownership
Three separate records sit behind a home's page, and they do not mean the same thing.
Fines
Federal money penalties, issued by CMS. A large fine usually follows a serious finding. Fines can be appealed and reduced, and the amount shown is what CMS recorded.
Payment denials
A separate and more severe step: Medicare stops paying for new admissions. It is used when a home has not fixed something serious. We show these apart from fines.
Ownership
Every facility page names how the home is run: for profit, by a non-profit, or by a government body. Medicare also publishes who owns each home and which chain it belongs to, and we load that file, but we do not yet build a page for an owner or a chain. When we do, this section will say so. Until then nothing on this site shows you how an owner's other homes perform.
What none of this tells you
Inspectors see one day. A clean record is not proof a home is safe, and an old finding does not mean the problem is still there. Use this to know what to ask about, then go and visit.
Where the numbers come from
Every figure on this site comes from the Centers for Medicare & Medicaid Services, from the Provider Information, Health Deficiencies, Penalties, Ownership and State US Averages files published on data.cms.gov. This page was built from the release dated August 1, 2026. CMS dates a release from the start of the month and puts it online on the last Wednesday of that month. The footer of every page says which release this site is running and the day we loaded it.
Nursing Homes Compared is not part of Medicare, CMS, HHS or any government agency, and is not endorsed by them.