Nursing home compare — and what the stars leave out

What the star rating is actually made of

Medicare's overall rating combines three separate ratings, and they often disagree with each other:

• Health inspections — the results of the last three annual inspection cycles plus complaint investigations, weighted so recent cycles count most. This is the backbone of the overall score.
• Staffing — nurse hours per resident per day, drawn from payroll data rather than self-reports, and adjusted for how sick the residents are. The national median is about 3.7 total nurse hours per resident per day.
• Quality measures — clinical outcomes such as falls, pressure ulcers, and hospital readmissions, most of which the facility reports itself.

A four-star overall rating can hide a two-star inspection history that was offset by strong self-reported quality measures. Always open the three component ratings separately — every facility page on this site shows all four side by side.

Blind spot 1: the rating describes the past owner

Ratings are built from up to three years of inspection history. When a facility is sold, the rating walks across to the new owner unchanged — it will take a year or more of inspections before the score reflects who is actually running the building today.

CMS publishes the ownership change; Care Compare doesn't headline it. We do: 50 facilities changed hands in the last 12 months, and each one carries a notice on its page telling you the rating predates the current operator.

Blind spot 2: the owner's other facilities are invisible

If a group runs 80 nursing homes and 60 of them rate poorly, that is the single most useful fact about the 80th — and it appears nowhere in a single-facility view. CMS publishes chain affiliation in its ownership file; Care Compare simply doesn't display it.

That is the gap this site was built to close. Our ownership group index aggregates every group's record: average rating, abuse citations, Special Focus facilities, and total federal fines across all of its buildings.

Blind spot 3: "no citations" isn't the same as "good"

Inspection intervals vary. A facility inspected 22 months ago with a clean sheet is not equivalent to one inspected last month with a clean sheet. Check the survey dates, not just the counts — and give heavy weight to any citation at scope/severity J, K, or L, which means inspectors found immediate jeopardy to resident health or safety.

Blind spot 4: assisted living isn't in it at all

Care Compare covers Medicare/Medicaid-certified nursing homes only. Assisted living is state-licensed, has no federal rating, and appears in no federal database — see our state-by-state assisted living records for what is public.

A practical comparison sequence

1. Shortlist by location and state records; note each facility's four ratings separately.
2. Read the deficiency timeline. Recent? Severe? Repeating the same failure?
3. Check staffing against the state median shown on each page, and look at nursing turnover.
4. Open the ownership group page. How do the owner's other facilities score?
5. Check the Special Focus list — facilities with the worst persistent problems in the country.
6. Then visit, with the citations in hand, and ask what changed.

Common questions

Is Nursing Home Compare the same as Care Compare?

Yes. Medicare renamed the old Nursing Home Compare tool; it now lives inside Medicare's Care Compare. Both refer to the same official star ratings and inspection data, which is also the source of the records on this site.

Are the star ratings reliable?

They are a reasonable starting point built from real inspection and payroll data, but they compress three different things into one number and lag ownership changes by a year or more. Read the component ratings and the underlying citations rather than the headline star.

Why does a facility have no rating at all?

Newly certified facilities and some specialty or government facilities lack enough inspection history to be rated. No rating is not a bad rating — but it does mean you should read the inspection records directly.

What does an abuse icon mean?

CMS flags facilities cited for abuse in recent inspections. It is a serious signal and appears on every affected facility page on this site.

Check a specific facility

Records for 14,693 nursing homes and 5,584 assisted living facilities: search by name or city · browse by state · by ownership group.