What is a cms five star rating?

CMS Five-Star rating is a public rating system used in the US to help people compare nursing homes and skilled-nursing facilities.

The rating is shown as 1 to 5 stars. It summarizes several categories, so a higher number usually means the facility performed better overall on the measures included—but it does not guarantee better care for your specific family member.

Northhaven Care is a free matching + information service, not a nursing home, a care provider, or a government program. If you want, we can help you find and compare options using the same public data sources families use, and we can explain what the numbers may mean for your situation.

Some participating facilities pay Northhaven Care a flat fee to be matched. This does not change what you pay, and it does not affect our guidance about Medicare or Medicaid—those rules are independent and available through official sources.

CMS Five-Star has three main components:

1) Health Inspections — Based on certain types of deficiencies found during surveys.

2) Staffing — How many nurses and nurse aides are working, measured in hours per resident per day (with specific attention to staffing patterns). Staffing ratio is a practical way to think about how many residents each nurse or aide is responsible for.

3) Quality Measures — Certain health outcomes and processes reported for residents (for example, whether certain conditions occur or whether certain care actions are tracked).

Start with the overall star score, but then look at the breakdown. A facility can have a higher overall rating while having weaker staffing or inspection results, or the reverse.

Pay special attention to staffing. Staffing—especially registered nurse (RN) hours per resident per day—often matters because it affects how quickly residents can be assessed and how shifts are covered when someone’s needs change.

Also remember: ratings are based on reported data and inspections over time. If a facility recently changed leadership, staffing, or services, the star rating may lag behind real-life changes. That’s why touring and asking detailed questions is still essential.

If you’d like step-by-step help, see How to choose a nursing home and Quality and ratings help.

People use the phrase nursing home in different ways, so it helps to clarify the type of care. “Skilled nursing” generally means round-the-clock care from licensed nurses and other therapy services when needed (for example after a hospital stay).

“Long-term care” usually refers to ongoing nursing assistance for someone who needs help with daily activities and may have ongoing medical needs.

CMS ratings apply to the facility level, not to whether a specific room or unit will meet your relative’s needs. When you compare facilities, ask whether they can provide the specific level of skilled services that your family member needs now and in the weeks ahead.

Northhaven Care can help you compare facilities based on publicly available quality and staffing information, but we do not provide medical advice or guarantee that a facility can accept a resident.

A higher star rating does not automatically mean lower cost. Prices can vary widely based on state, room type (for example, private vs. shared), and level of care.

As a rough US range, nursing-home and skilled-nursing care often falls around $7,000–$13,000+ per month, but the real number depends heavily on your location and how the facility bills. If you’re comparing options, it’s wise to ask about total monthly estimates for the type of room and care you need.

Payment rules also matter. Medicare may cover short-term skilled nursing for up to 100 days after a qualifying hospital stay, with cost-sharing after day 20. Medicaid can cover long-term nursing care for those who qualify based on income and assets, and rules vary by state.

For cost planning and insurance basics, check official sources like Medicare.gov and your state Medicaid office. (If you want help understanding general categories, Northhaven Care can explain common billing terms and what to ask, without giving financial advice.)

A tour and direct questions help you validate what the stars cannot capture. Ask to see how staffing is handled across different times of day, including evenings and weekends.

Ask practical questions such as:

- How many nursing staff are scheduled per shift, and how does staffing change on weekends and nights?
- What is the facility’s approach when a resident’s condition changes?
- How are care needs communicated during shift changes?
- How do they involve families, and where do you find updates about your loved one?

If you’re worried about care quality, ask how the facility monitors outcomes internally and how concerns are addressed. If you believe something is unsafe, you can also contact the state survey agency and your state’s long-term-care ombudsman for guidance.

If you’d like a free way to compare options, you can request matching at Get matched. You can ask for help in your preferred language—care eligibility and support options are separate from immigration status.