Are you losing sleep over your facility’s 5-star rating? You’re not alone. Many nursing home administrators struggle to decode the CMS 5-Star Rating System for nursing homes—especially when trying to improve it. While a star rating isn't the only indicator of care, it is one of the most influential benchmarks used by families, partners, and staff to evaluate long-term care facilities.
This system—created by the Centers for Medicare & Medicaid Services (CMS)—is publicly available on the Medicare Care Compare website, and it grades every nursing home across three domains: health inspections, staffing, and quality measures. Understanding these categories and how they contribute to your overall star rating is key to strengthening your reputation, improving care outcomes, and increasing your financial viability.
Whether you're hiring, building community trust, or pursuing value-based contracts, your nursing home’s star rating is more than a number—it’s a strategic asset.
Facilities with higher CMS 5-star ratings tend to:
In fact, a one-star improvement can lead to a 3–5% increase in private-pay census. For a 100-bed nursing home, that can translate into hundreds of thousands of dollars in annual revenue.
CMS assigns nursing homes an overall star rating from one to five, based on performance in the following three weighted categories:
Understanding how CMS calculates these ratings is essential for identifying targeted improvement opportunities. The CMS nursing home star ratings are updated quarterly, giving facilities regular opportunities to improve their standing.
The best place to start when trying to boost your 5-star rating is your quality measures. This category reflects the outcomes and care standards within your facility, and small, strategic changes can lead to significant improvements. Improving your quality of care for residents while simultaneously improving your quality measures can result in better care for residents, which everyone should focus on.
Some measures carry more weight than others, meaning targeted improvements can lead to significant rating increases with focused effort.
Several metrics can impact your 5-star rating, inlcuding hospitalization rates, antipsychotic prescription rates, and pressure ulcers.
One of the key components of quality measures is your hospitalization rate. Facilities with high rates of hospital transfers may be signaling that they:
Lowering unnecessary hospital visits doesn't just help your rating; it's a clear sign your team is delivering competent, proactive care.
Strategies to reduce hospitalizations and improve your CMS nursing home rating:
Facilities that reduce their hospitalization rates by just 10% often see measurable improvements in their CMS 5-star rating for nursing homes.
Antipsychotic medication use is another important factor. Unless prescribed for schizophrenia, Huntington's disease, or Tourette's Syndrome, these medications can negatively impact your quality score. Work closely with your Medical Director and consultant pharmacist to:
Even a modest reduction in usage can significantly boost your facility's quality score. The national average for long-stay antipsychotic use is around 14%, with 5-star facilities typically maintaining rates below 10%.
New or worsening pressure ulcers are not only painful and dangerous for residents, but they're also another care category in the quality measures. These ulcers often reflect poor staffing levels, inadequate repositioning schedules, or ineffective wound care practices.
To reduce this risk:
CMS particularly focuses on Stage 2-4 pressure ulcers in the five star rating calculations, making this an area where focused improvement efforts can yield significant rating gains.
Beyond hospitalizations, antipsychotic use, and pressure ulcers, the CMS quality measures also include:
Review each of these indicators individually to identify specific improvement opportunities.
The CMS Nursing Home Compare website is more than a public directory—it’s a performance dashboard for administrators.
Features include:
Use it regularly to spot trends, monitor changes, and identify where to focus your improvement efforts.
In today's healthcare landscape, your CMS 5-star rating increasingly affects your bottom line. Value-based purchasing programs often tie reimbursement rates directly to quality measures, many of which overlap with the CMS star rating metrics.
Nursing homes with higher CMS star ratings typically:
This financial incentive makes investing in quality improvement not just good for residents, but essential for long-term business sustainability.
Improving your 5-star rating is absolutely possible, but it requires honest self-assessment, team collaboration, and a commitment to continuous improvement. The good news? Even simple, focused steps can create meaningful change, not just in your numbers, but in the daily experiences and health outcomes of your residents.
Because at the end of the day, quality care should be the true goal. The rating? That's just the reflection of how well you're delivering it.