Why your ratings are part of your marketing
CMS tells families to check star ratings. Its nursing home visit checklist, Questions to Ask When You Visit a Nursing Home, asks them to look up the overall rating and the health inspection, staffing and quality measure ratings on Care Compare, read the latest inspection report and ask whether citations were corrected.
Hospitals use the same data. The hospital discharge planning rule says a hospital must give the patient a list of available home health agencies, skilled nursing facilities and other post-acute providers, and must use and share data on quality measures when helping the patient choose, under 42 CFR 482.43. So the case manager who could send you a patient may be looking at the same numbers the family sees.
You cannot change your ratings from your website. You can decide whether families meet them for the first time on Care Compare with no context, or on your site with an honest explanation.
How nursing home star ratings are built
Every nursing home that participates in Medicare or Medicaid gets an overall rating of one to five stars plus three domain ratings: health inspections, staffing and quality measures. The details below come from the CMS Five-Star Quality Rating System Technical Users' Guide, September 2026 edition.
Health inspections. This rating comes from the two most recent standard inspections, plus complaint investigations and focused infection control surveys from the last three years. CMS changed from three standard surveys to two starting with the July 2025 refresh. Deficiencies earn points by scope and severity, and repeat revisits add points. The most recent standard survey counts for three quarters of the weight and the one before it for one quarter.
The inspection rating is graded on a curve within your state. The top 10 percent of homes in each state get five stars, the bottom 20 percent get one star, and the middle 70 percent are split evenly across two, three and four stars. That means a home can improve and still not move up if other homes in the state improve too.
Staffing. Six measures: total nurse hours per resident day, registered nurse hours per resident day, weekend total nurse hours, total nursing staff turnover, registered nurse turnover and administrator turnover. The data comes from the Payroll-Based Journal system that homes submit each quarter.
Quality measures. Fifteen of the measures posted on Care Compare, nine for long-stay residents and six for short-stay residents, drawn from resident assessments and claims. CMS also shows separate short-stay and long-stay quality ratings.
Overall rating. CMS starts with the health inspection rating. It adds a star if staffing is five stars and subtracts one if staffing is one star, then does the same for quality measures. A home with a one-star inspection rating cannot be raised by more than one star. In short, inspections drive the overall rating.
The icons families notice
Three flags on Care Compare change how a family reads your listing. All three are described in the same CMS guide.
- Abuse icon. Shown for a harm-level abuse citation in the most recent cycle, or for repeat abuse citations. A home with the icon has its health inspection rating capped at two stars, so its overall rating can be no better than four. The icon comes off at the first monthly refresh after the home no longer meets the criteria.
- Special Focus Facility. Homes in the SFF program get no star ratings. Care Compare shows a yellow warning sign in place of the overall rating.
- Trophy icon. Starting with the September 2026 refresh, homes that perform highly get a trophy icon in addition to a five-star rating. CMS describes these as homes with fewer citations, higher staffing and other quality indicators, and refers providers to memo QSO-26-14-NH for the criteria.
Inspection reports, not just stars
Stars are a summary. Many families, and most experienced discharge planners, click through to the inspection details. Care Compare shows the third most recent standard inspection even though it no longer counts toward the rating, and it shows citations that are still under informal dispute, according to the CMS guide.
Your building already has a duty here. Certified homes must post the results of the most recent survey where residents and families can see them, and keep three years of survey, certification and complaint reports and any plan of correction available for anyone who asks, under 42 CFR 483.10(g)(11). A website that links to the same information is consistent with what you already do in the lobby.
Home health and hospice ratings
Home health agencies have two star ratings on Care Compare, per CMS's home health star ratings page. The Quality of Patient Care rating uses OASIS assessments and claims across seven measures, including timely start of care, improvement in walking, transferring, bathing, breathing and taking oral medications, and potentially preventable hospitalizations. The Patient Survey rating comes from the Home Health CAHPS survey. Both are updated quarterly, and an agency needs a minimum amount of data to be rated at all.
Hospice is different. Care Compare shows hospice quality measures from the HOPE assessment tool, the CAHPS Hospice Survey and Medicare claims, along with CAHPS-based star ratings, according to CMS's hospice public reporting page. CMS removed one CAHPS measure, training family to care for the patient, from public reporting starting with the May 2026 refresh and expects to bring it back in February 2028. If a family asks why that score is missing, that is why.
Assisted living is not rated by CMS. If you run assisted living, the inspection records families can find are kept by your state, so check what your licensing agency publishes.
How to address your ratings on your site
The right approach depends on where you stand, but the rule is the same everywhere: say only what is true, date it, and link to the source so anyone can check.
- Strong ratings. Say it plainly, name the rating and the month, and link to your Care Compare page. Update it when the rating changes. An old five-star badge on a home that is now three stars is worse than no badge.
- Middle ratings. Lead with what families can see for themselves on a tour, then link to Care Compare. If one domain is strong, say which one. A four-star staffing rating is worth mentioning on its own.
- Weak ratings or a recent bad survey. Write a short note in plain words. What was cited, what you changed, who is responsible and how a family can ask about it. Invite them to read the report. Do not argue with surveyors on your website.
- Abuse icon or SFF status. Talk to your compliance officer or counsel before you publish anything. Any statement should be reviewed, factual and limited to what the facility has done in response.
- New buildings. A home needs two standard surveys before CMS assigns ratings, so a new building shows Not Available. Say that on your site so families do not assume something is wrong.
What not to do
Do not use the Medicare or CMS logo, or wording that suggests CMS endorses you. A star rating is a measurement, not an award, apart from the trophy icon CMS itself displays.
Do not claim a rating you no longer have. Ratings change monthly as new inspections, complaint surveys and dispute results arrive, and the CMS guide notes that older complaint citations lose weight over time. Put the date next to any rating you mention and check it each month.
Do not write reviews or testimonials to bury a bad rating. The FTC's Consumer Reviews and Testimonials Rule bans fake reviews and testimonials and undisclosed insider reviews, and allows civil penalties for knowing violations.
This guide explains how CMS describes its methods. For anything you publish about a citation, an abuse finding or a dispute, confirm the wording with your compliance officer or counsel.
Checklist
- Find your current Care Compare listing and note the date of each rating
- Link to that listing from your quality or about page
- If you mention a star rating, show the month it was current and set a monthly reminder to check it
- Write a short, factual note about any recent survey families will see, and have it reviewed
- Point families to the posted survey results in your building and offer to share the reports
- Remove any badge, logo or claim that is out of date or suggests CMS endorsement
- Home health and hospice: check which star ratings you have and which measures are shown
Questions
How often do nursing home star ratings change?
They can change any month. CMS recalibrates inspection cut points monthly, and a facility's rating can move with a new inspection, a complaint survey with citations, a revisit, a resolved dispute, or older complaint citations aging into a lower weight.
Why did our rating drop when nothing changed in the building?
The health inspection rating is ranked against other homes in your state, so your rating can move when the statewide distribution moves. Changes in staffing or quality measure ratings can also shift the overall rating by a star in either direction.
Should we explain a bad survey on our website?
Usually yes, briefly and factually, with a link so families can read the report. Families will find it on Care Compare anyway. Have your compliance officer or counsel review the wording before it goes live.
Does assisted living have Care Compare star ratings?
No. CMS star ratings cover Medicare and Medicaid certified providers such as nursing homes, home health agencies and hospices. Assisted living is licensed and inspected under state rules, so any public inspection records come from your state agency, and what each state publishes varies.
Sources
- CMS: Nursing Home Five-Star Quality Rating System Technical Users' Guide (Sept. 2026)
- CMS: Five-Star Quality Rating System
- CMS-12130: Questions to Ask When You Visit a Nursing Home (Nov. 2022)
- eCFR: 42 CFR 483.10 Resident rights
- 42 CFR 482.43 Discharge planning (LII)
- CMS: Home Health Star Ratings
- CMS: Hospice Public Reporting, Background and Announcements
- FTC: Consumer Reviews and Testimonials Rule, Questions and Answers
This guide is general information, not legal advice. Confirm regulatory and legal questions with your compliance officer or counsel.
