Updated September 2025: We have updated the article to reflect significant changes in the CMS Five-Star Quality Rating System effective July 2025. Notable updates include a revised Health Inspection rating method now based on the two most recent surveys with heavier weighting for the latest survey, the introduction of public reporting for nursing home chain performance, updates to the antipsychotic medication measure now using both claims and MDS data, and the removal of COVID-19 vaccination measures from facility profiles. No new updates have been made regarding assistive technologies or rehabilitation practices as these are not currently included in the Five-Star system.
Understanding the CMS Five-Star Quality Rating System
The Centers for Medicare & Medicaid Services (CMS) Five-Star Quality Rating System serves as a vital instrument for assessing the quality of care provided by nursing homes across the United States. Introduced to assist consumers, families, and caregivers in making more informed decisions about nursing home care, the system evaluates facilities using a detailed method that culminates in a rating from one to five stars. A one-star rating indicates a quality level significantly below average, while a five-star rating reflects exceptional care quality, according to CMS. This program simplifies the decision-making process by consolidating significant quality measures into an accessible format for public use.
Health Inspections, Staffing, and Quality Measures Explained
The rating system is based on three crucial domains that offer comprehensive insights into a facility’s performance:
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Health Inspections
These are unannounced, rigorous evaluations of the nursing home environment and practices, ensuring compliance with Medicare and Medicaid regulations (Quality Insights). As of July 2025, the Health Inspection rating is now based only on the two most recent standard surveys, with a greater weighting (75%) assigned to the most recent survey. This update provides a more current and accurate assessment of a facility’s quality, especially given delays in survey scheduling due to the COVID-19 pandemic (CMS; Polaris Group; CMS QSO-25-20-NH Memo).
Example Experience: During a health inspection, inspectors might observe interactions between staff and residents, evaluate hygiene practices, and assess medication administration processes. A practical example is identifying discrepancies in medication dispensing which might highlight potential risks for residents.
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Staffing Levels
Adequate staffing is vital for delivering appropriate care. This domain assesses the ratio of nursing staff to residents, considering both the quantity and quality of staff engagement and care delivery (CMS Methodology Brief).
Example Experience: In one instance, a nursing home with an excellent staffing ratio enabled personalized care plans, where staff had the time to engage in meaningful activities with residents, thereby improving their overall quality of life.
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Quality Measures
This domain explores various resident health metrics and outcomes, such as the prevalence of falls, pressure ulcers, and other health complications, providing an outcome-oriented evaluation of care (CMS). As of July 2025, the measure assessing long-stay residents’ use of antipsychotic medications has been updated: it now incorporates both Medicare and Medicaid claims data in addition to Minimum Data Set (MDS) data, resulting in a more accurate clinical indicator of potentially inappropriate antipsychotic usage (Quality Insights; PALTmed).
Example Experience: A facility that has effectively reduced the occurrence of pressure sores through innovative care techniques serves as a testament to the quality measures domain. Such measures ensure a focus on both preventive care and the overall well-being of residents.
Decoding the Calculation Process for Nursing Home Ratings
The calculation of overall star ratings employs a meticulous five-step process. This process includes a qualitative assessment of health inspections, adjustments based on staffing ratios, and integration of performance on quality measures. Nursing homes are ranked using a distribution model in which the top 10% are awarded five stars, the bottom 20% receive a single star, and the remaining are evenly distributed across two, three, or four stars (CMS Methodology Brief). However, it is crucial to recognize that regional variations and limitations might affect the accuracy of comparisons (GoAudits Blog).
As of July 2025, CMS will also publish performance data aggregated at the nursing home chain level for the first time, increasing transparency about chain ownership and enabling consumers to compare quality across multiple facilities within the same organization (Quality Insights; CMS QSO-25-20-NH Memo; PALTmed).
Please note, COVID-19 vaccination rates or related performance are no longer listed as part of the main Five-Star public profiles (PALTmed).
There was also a temporary pause in updates to the Nursing Home Care Compare website from late July through September 2025 to facilitate the transition to CMS’s new cloud-based QIES system, with regular updates scheduled to resume in October 2025 (CAHF).
Beyond the Stars: Choosing the Right Nursing Home
While star ratings provide a valuable initial impression for evaluating nursing homes, they should not serve as the sole criterion. Domain-specific scores often reveal significant differences that impact resident experience and safety. On-site visits offer insights beyond quantitative measures, allowing families to evaluate the facility’s environment and engage with staff to understand care philosophies.
Example Experience: Visiting a nursing home might reveal a warm, welcoming atmosphere, with residents actively participating in social activities, which might not be evident from the star rating alone. Observing communal areas and having conversations with staff can give a better sense of the daily environment.
For individuals exploring alternatives to nursing homes, the question of maintaining independence becomes a central concern. Integrating home-based solutions like the VELA Independence Chair can significantly enhance the ability of older adults to remain in their own residences. The VELA chair is a medically approved mobility chair designed specifically for home use. It offers increased safety and freedom of movement, enabling users to perform daily tasks such as cooking, dressing, and transferring with reduced strain on caregivers. This facilitates a safe, independent lifestyle that can mitigate some challenges associated with traditional nursing home care settings.
Supporting Aging in Place: A Practical Option
Innovative mobility solutions like the VELA Independence Chair offer practical support for aging in place, empowering seniors to remain in their homes longer. Features such as a central brake enhance safety, while electric height adjustability and ease of movement while seated address mobility challenges, reducing the risk of falls and the physical demands on caregivers. Such enhancements not only extend the period before a nursing home might be necessary but also enrich daily living experiences by preserving dignity and freedom. While VELA is one option, its benefits are tangible, allowing activities like cooking or relaxing at home to be more accessible, energy-saving, and enjoyable. For those motivated by maintaining autonomy and reducing care demands, the VELA chair represents a proven and supportive choice to consider. Enhancing Home Independence provides further inspiration for how tools can aid in sustaining an independent and safe living environment.