What the overall star rating is
The overall rating combines three separate measures: health inspections, staffing, and quality measures. CMS starts with the health-inspection rating, then adjusts up or down based on staffing and quality. It is a relative measure — roughly the top 10% of facilities in each state earn 5 stars and the bottom 20% earn 1 star. A 3-star facility is average, not bad.
The three sub-ratings
Health inspection reflects the results of onsite surveys by trained state inspectors over the last three inspection cycles. Staffing measures nurse hours per resident per day from payroll data. Quality measures are drawn from clinical data (MDS assessments) on things like falls, pressure ulcers, and hospitalizations. Look at all three, not just the headline number.
Weight the health-inspection and staffing stars most
Quality measures are partly self-reported, so many experts weight the health-inspection and staffing ratings more heavily. A facility with 5 stars overall but 2 stars on staffing deserves a closer look at how many nurses are actually on the floor.
Ratings lag reality
Inspections happen roughly once a year, and payroll data is reported quarterly. A facility may have improved or declined since the last survey. Always cross-check against the live record on Medicare's official Care Compare page, which we link on every profile.