Most families choose a nursing home under pressure, often while a parent is still in the hospital and a discharge planner needs an answer within days. Medicare's Care Compare tool is the best free starting point: it lists every Medicare- or Medicaid-certified nursing home with ratings, inspection reports, staffing data and quality measures1. But the single overall score is easy to misread.
This guide explains how Care Compare's ratings are built, which parts to trust most, the warning signs to look for, and how to confirm what you read with visits and the right questions. For background on the setting itself, see our nursing homes guide.
Before you compare: what you need
- Short stay or long stay? Rehab after a hospital stay and long-term care have different needs. Care Compare reports separate quality measures for each.
- Who will pay, now and later? If Medicaid may pay later, choose a home that participates in Medicaid. A home cannot ask your parent to promise not to apply for Medicare or Medicaid2. Our guide on how to pay for a nursing home explains how families plan for costs.
- Special needs. Dementia care, ventilator or dialysis support, wound care, a language spoken by staff, or a particular faith tradition.
- Location. Closeness to family visitors matters for both quality and well-being. Visitors notice problems early.
If your parent is in the hospital, ask the discharge planner for the list of homes with openings, then look each one up on Care Compare. You can compare up to three homes side by side3.
How Care Compare's ratings work
CMS gives most certified nursing homes an overall rating from 1 (much below average) to 5 (much above average), plus a separate 1-to-5 rating in each of three areas: health inspections, staffing and quality measures4.
| Area | What it measures | Where the data comes from |
|---|---|---|
| Health inspections | Number, scope and severity of problems found by inspectors, plus repeat visits needed to confirm fixes | The two most recent standard surveys, plus three years of complaint and infection control inspections |
| Staffing | Nurse staffing hours per resident per day (total, registered nurse and weekend) and turnover of nurses and administrators | Payroll records the home submits each quarter, adjusted for how sick residents are |
| Quality measures | Resident outcomes such as falls with injury, pressure injuries, antipsychotic use, hospital visits and return home after rehab | Resident assessments and Medicare claims; 9 long-stay and 6 short-stay measures count toward the rating |
Source: CMS Technical Users' Guide, September 2026.
How the overall rating is calculated
The overall rating is not an average. CMS starts with the health inspection rating, then moves it up one point if the staffing rating is a 5 or down one point if staffing is a 1. It then moves the result up one if the quality measure rating is a 5 or down one if it is a 1. If the inspection rating is a 1, the overall rating can rise by no more than one point4.
CMS designed it this way on purpose: findings from trained inspectors on site are treated as the most important signal, and staffing and quality data can only shift the result. That is why we suggest reading the inspection rating and the inspection report before anything else.
Inspection ratings are graded within each state
Because inspection practices vary by state, CMS ranks inspection results against other homes in the same state. In each state, roughly the best 10 percent get a 5, the bottom 20 percent get a 1, and the middle 70 percent are split evenly across 2, 3 and 44. A 4 in one state is not directly comparable to a 4 in another. Compare homes in the same state.
Reading inspection reports
Behind the inspection rating is the full report of every deficiency, or citation, found by state inspectors. Each one is graded by severity (from potential for minimal harm up to immediate jeopardy to resident health or safety) and scope (isolated, a pattern, or widespread). The rating weighs the most recent standard survey three times as heavily as the one before4.
- Look for harm. Citations at level G or higher mean residents were actually harmed. A few minor paperwork citations are common; harm citations are not.
- Look for themes. Repeated citations about falls, pressure injuries, medicines, infection control or staffing tell you more than the count alone.
- Read complaint inspections. These show problems reported by residents, families or staff between routine surveys.
- Check the date and the fix. Ask the home what changed after each serious citation. A clear, specific answer is a good sign.
Care Compare links to inspection details for each home5. Many state health departments also post full inspection reports and state enforcement actions; our guide to checking a license and inspection report shows where to look.
Staffing: hours and turnover
Staffing may be the most practical number for daily life in a nursing home. The staffing rating combines three measures of nurse hours per resident per day (total nursing staff, registered nurses and total staffing on weekends) with three turnover measures: nursing staff, registered nurses and the administrator4. Hours are adjusted for how much care residents need, so a home with sicker residents is expected to staff more.
- Weekend hours. A big gap between weekday and weekend staffing can mean slower help on Saturdays and Sundays.
- Registered nurse hours. RNs handle assessments and changes in condition. Low RN hours can mean problems are caught later.
- Turnover. CMS notes research linking higher staff turnover with poorer resident outcomes4. High turnover also means aides who do not know your parent.
- Administrator turnover. Frequent leadership changes often come before or with quality problems.
Because staffing data comes from payroll records rather than self-reported snapshots, it is harder to dress up for a survey week. Still, ask on your visit how many residents each aide cares for on day, evening and night shifts.
Quality measures: short stay and long stay
Quality measures track outcomes for residents. Care Compare reports a quality rating overall and separate ratings for short-stay (mostly rehab) and long-stay residents. Fifteen measures count toward the rating: nine long-stay and six short-stay4.
- For rehab after a hospital stay. Look at short-stay measures such as rates of returning home, rehospitalization and new or worsening pressure injuries.
- For long-term care. Look at long-stay measures such as falls with major injury, pressure injuries, use of antipsychotic medicines, weight loss and hospital use.
- Remember the limits. Many measures come from assessments the home itself completes. CMS audits some coding and can lower a home's quality rating when it finds errors4.
Use quality measures to spot strengths and red flags, not to choose by decimal points. A home that looks average overall but strong on the measures that matter for your parent can be a good fit.
Red flags to look for
- The abuse icon. Care Compare shows an icon for homes cited for abuse that harmed residents recently, or for repeated abuse citations. These homes' inspection ratings are capped at 2, so their overall rating can be no higher than 44. Treat the icon as a serious warning even if the overall score looks fine.
- Special Focus Facility. A home in this program has a history of serious quality problems and gets extra inspections. It shows a warning symbol instead of ratings4.
- Recent harm citations. Any citation at level G or higher in the last year deserves a direct question.
- Very high turnover. Especially among nurses and the administrator.
- Missing data. Ratings that are not available, or that changed sharply, deserve an explanation.
Visit and ask the right questions
Numbers narrow the list; visits decide it. Medicare suggests watching for slow responses to call lights, strong odors, residents calling out, and safety risks such as residents wandering without supervision, and talking with residents and families if you can36.
- Visit at least twice. Once scheduled, once unannounced. Try a mealtime, an evening or a weekend.
- Watch the floor, not the lobby. Are residents up, dressed and engaged? Do staff speak to them by name? How long do call lights stay on?
- Eat or watch a meal. Is help with eating unhurried? Are there choices?
- Talk to the ombudsman. Your local long-term care ombudsman knows complaint patterns and can share general information about homes7.
- Read the admission agreement. Take it home before signing. Ask about bed holds, discharge, and how charges change.
Questions to ask the administrator or director of nursing:
- Staffing. How many residents does each aide care for on each shift? Do you use agency staff? How long have the director of nursing and administrator been here?
- Care planning. How often is the care plan reviewed, and how are families included? Our guide to care plan meetings explains what to expect.
- Medical care. How often does a physician or nurse practitioner visit? What happens after hours?
- Inspections. What changed after your most recent serious citations?
- Dementia care. How do you handle agitation without relying on antipsychotic medicines?
- Medicaid. Do you accept Medicaid, and will my parent keep the same room if they switch to Medicaid?
Paying for a nursing home
Medicare Part A covers a limited stay in a skilled nursing facility after a qualifying hospital stay when daily skilled care is needed, but it does not pay for long-term custodial care89. Medicaid is the main payer for long-term nursing home care for people who qualify; our guide to Medicare vs. Medicaid for long-term care explains the rules, and our guide to the Medicaid spend-down shows how families qualify once savings run low. Our guide to skilled nursing vs. nursing home care explains the difference.
A home may not require a family member to personally guarantee payment as a condition of admission or continued stay. It may ask a representative who has legal access to the resident's money to sign so bills are paid from the resident's own funds, without personal liability2. Read our guide to the nursing home admission agreement before signing. Read any agreement carefully before signing on a parent's behalf.
Veterans may have options too. VA operates and contracts for nursing home care, and State Veterans Homes serve eligible veterans10. Wartime veterans and surviving spouses who need help with daily activities may qualify for VA Aid and Attendance11.
Still deciding whether a nursing home is the right setting? Compare assisted living vs. nursing home, memory care vs. nursing home, or care at home, or take the care quiz.
