The U.S. Centers for Medicare & Medicaid Services, or CMS, has established a star rating system to help families and caregivers more easily compare nursing homes. A recent study finds that the system may be less reliable than intended. It indicates that ratings may change from month to month for reasons not clearly tied to real changes in care quality, and that a 3-star rating can mean different things depending on the state or year, which can make comparisons confusing.
Table of Contents:
An Overview: Research Findings on CMS’s Star Rating
In the study Choosing a Nursing Home: How Useful Are CMS Star Ratings?, researchers from Georgetown University, Northwestern University, and Texas A&M University evaluate how well CMS ratings help families compare nursing homes. The study examined the CMS star ratings published monthly from 2009 through 2024. Overall, the findings suggest that the system is less helpful to families as the ratings can be inconsistent and difficult to interpret.
Star Ratings Change Often for Individual Homes Due To Unclear Reasons
The study finds that nursing homes’ overall star ratings change frequently from month to month, and very few facilities consistently maintain the same rating. Some of this change is not tied to real shifts in care quality, but rather to “opaque, time-varying design details” within the rating system. Researchers note that this general volatility can undermine the credibility and usefulness of the star rating system when its causes are not transparent.
Star Rating Meanings Vary by State, Time Period
The study explains that what counts as an “average” 3-star nursing home can vary widely by state and time period, making comparisons between facilities confusing or misleading. For example, a 3-star facility in California in 2012 may have been above average at that time, while a 3-star facility in another state in 2024 may fall below the national average.
Why This Matters for Families Researching Nursing Homes
These findings matter to families because CMS star ratings are often used as a quick way to judge nursing home quality, but they do not always give a clear or steady picture. A high rating may not always mean consistently better care, and an “average” rating can mean different things depending on where and when you look. As a result, families who rely only on star ratings may miss important warning signs or misunderstand how a facility is actually performing.
What Is CMS’s Star Rating Methodology?
CMS uses a five-star rating system to rate nursing homes across three main areas: health and safety inspections, staffing levels, and quality of care measures. Each area gets its own sub-rating. CMS combines these three sub-ratings into an overall star rating of 1 to 5, intended to help families compare nursing homes at a glance. The methodology behind this system is complex, and the agency’s website provides a detailed explanation in a 30-plus page user guide.
What Families Should Consider When Using The Star Rating System
The study shows CMS star ratings do not always give families a clear or steady picture of nursing home care. Because of this, families should not rely solely on a facility’s star rating when choosing a facility.
Instead, families should use multiple sources to get a fuller picture of care quality:
- Review state inspection reports and complaint histories available through ProPublica’s Nursing Home Inspect tool.
- Read online reviews from residents and family members to understand day-to-day experiences.
- Ask trusted doctors and nurses, social workers, local church groups or clergy who visit homes, or other professionals, for recommendations or insight on a particular facility.
- Visit facilities in person when possible to observe staffing, cleanliness, and resident care.
Speak With A Nursing Home Abuse Lawyer Today To Begin Your Journey to Justice
While CMS’s star ratings can offer some insight into a nursing home, they do not always reflect the full reality. Lanzone Morgan, LLP, focuses exclusively on elder abuse cases. Our California nursing home abuse lawyers are committed to helping victims and their families seek compensation and hold negligent nursing homes accountable.
If you are concerned about the care your loved one is receiving in a nursing home, we can help. Contact us online or call (888) 887-9777 today to speak with an experienced nursing home abuse lawyer to understand your rights and next steps.