A five-star nursing home on Medicare's Care Compare can be carrying a one-star rating underneath, because the overall star is a weighted composite of three separate scores. That is easy to miss, partly because the choice usually gets made fast, and for the first time, while a parent is being discharged from the hospital. This guide is a plain method for how to choose a nursing home with confidence: seven steps that move you from a list of homes to a decision you can stand behind, using the ratings the way they're meant to be used instead of taking them at face value.

In This Guide

Start Here: How to Choose a Nursing Home

You already have a strong, free tool for this, and it's the same one professionals use. Medicare Care Compare shows a Five-Star rating for nursing homes certified by Medicare and Medicaid.

The overall star is worth trusting as a starting filter, but it's a composite, and it can smooth over a serious weakness in one part of the home's record. So the method below does two things at once. It uses Care Compare to build and narrow your list quickly, and it teaches you to read past the headline number to the parts that actually predict care. Take the steps in order. Each one builds on the last, and none of them takes long once you know what you're looking at.

Step 1: Find Homes on Medicare Care Compare

Open Care Compare and search by your parent's ZIP code or city, then filter for nursing homes (Care Compare also lists other provider types, so make sure you're on the nursing-home tab). You'll get a map and a list of the certified homes in the area, each showing its overall star rating.

At this stage you're just building a working list, not deciding anything. Cast a slightly wider net than feels necessary, because some of the homes that look good on the overall star will drop off once you open the details, and a couple that look average will move up. Aim for a starting list of maybe eight to twelve homes within a reasonable distance, keeping in mind that being close enough for family to visit often matters as much as any single rating.

Step 2: Open All Four Ratings, Not Just the Overall Star

Every home has four numbers to look at, not one: the overall star, plus the three sub-ratings underneath it. Medicare's overall star rating for a nursing home is a weighted composite of its health inspection, staffing, and quality-measure ratings, with the health inspection carrying the most weight and the other two adjusting it up or down.

Because it's a composite, the overall star can hide a low sub-score. A home can show four or five stars overall while one of its underlying ratings sits at one or two stars. That buried number might be exactly the thing that matters most for your parent's situation. So for every home on your list, click into the profile and write down all four ratings, not just the headline. If you want the full picture of how the composite is built and where its blind spots are, our companion guide walks through what the star ratings actually mean.

Step 3: Weigh the Independent Inspection Over the Self-Reported Scores

The three sub-ratings are not made the same way, and only one of them is produced by an outsider.

The health inspection rating comes from on-site surveys done by state inspectors, not from anything the home reports about itself. The Medicare health inspection rating is built from a nursing home's two most recent standard inspections plus complaint and infection-control findings over roughly the last three years, weighted by how serious and widespread the problems were. The staffing rating, by contrast, is calculated from hours the home itself reports to Medicare each quarter through the federal Payroll-Based Journal system, and the quality-measure rating draws on the home's own resident assessments combined with Medicare claims data, with an automated check on whether that data is complete.

Rating Who produces the data What it is built from
Health inspection State inspectors, on site The two most recent standard inspections, plus complaint and infection-control findings over roughly the last three years
Staffing The nursing home Payroll hours the home reports to Medicare each quarter
Quality measures The nursing home, plus Medicare claims The home's own resident assessments combined with Medicare claims data

So two of the three ratings rest on numbers the facility supplies. That doesn't make the self-reported scores useless, but it tells you how to weight them: lean hardest on the health inspection, and treat staffing and quality measures as useful signals to verify rather than facts to take on faith. Two more cautions belong here. First, a one-star staffing score isn't always about thin staffing; a home can land there for missing a data deadline, failing a Centers for Medicare & Medicaid Services (CMS) data audit, or not having a registered nurse on-site every day. That's a question to ask on your tour, not an automatic disqualifier. Second, the inspection rating is curved within each state, with the top 10% of homes scoring five stars and the bottom 20% scoring one, so a five-star inspection rating in one state isn't the same as one in another. Compare homes within your own state, not across state lines.

Step 4: Cross-Check the Special Focus Facility List

The star ratings don't capture everything, and one thing they can miss is a home with a documented pattern of serious problems. That's what the Special Focus Facility program tracks. CMS identifies the poorest-performing homes in each state, puts them under heightened oversight with in-person inspections about twice as often as other homes, and moves toward termination from Medicare and Medicaid if they don't improve.

There are two lists to check: the smaller roster of current Special Focus Facilities, and a larger list of "candidate" homes flagged for possible selection. A home on the candidate list can still be showing a middling star rating, which is exactly why this cross-check matters. If a home you're considering appears on either list, that doesn't automatically rule it out, but it raises the bar for what you'll want to see on your tour and in the inspection report.

Step 5: Look for the Abuse Icon

One more thing to check on each home's Care Compare profile is the abuse icon, a small red hand. Medicare adds the red-hand abuse icon to a nursing home's Care Compare profile when the home has been recently cited for abuse or neglect that harmed a resident, or could have. A nursing home carrying Medicare's abuse icon has its health inspection rating capped at two stars, which limits its overall Care Compare rating to no more than four.

Read the icon for what it is: a flag on a recent, specific citation, not a permanent judgment and not a guarantee that an unflagged home is problem-free. If you see it, go read the underlying inspection report (Step 7) to understand what actually happened before you weigh the home in or out.

Step 6: Shortlist, Then Tour With the Right Questions

By now your list should have narrowed to two, three, or four homes worth visiting in person. The visit is where the ratings turn into real questions, and the trick is to let each home's own numbers drive what you ask.

If a home had a low staffing star, ask directly about registered-nurse hours, weekend and overnight coverage, and how many residents each aide is responsible for on a typical shift. Ask about turnover too, and bring the published numbers with you: the staffing star reflects more than daily nurse-staffing hours, because it also incorporates staff-turnover measures, including how many nurse staff stopped working at the facility and how many administrators left within a given year. If a quality measure looked weak, ask how the home tracks that specific issue, whether it's falls, pressure sores, or pain, and what it changed after its last inspection. Beyond the rating-keyed questions, pay attention to the things a survey can't score: whether call lights are answered, whether residents are up and engaged or parked in hallways, whether the staff seem to know residents by name, and how the place smells and sounds at an unplanned moment. Try to visit once around a mealtime, when staffing and dignity are both on display.

Step 7: Read the Inspection Report, Then Decide

From a home's Care Compare profile you can open its actual inspection results, the specific deficiencies state surveyors cited and what the home did in response. This is the step that turns a star into a story.

Read for pattern and severity, not just count. A single low-level, one-time citation that the home corrected is very different from serious violations, or the same problem cited again and again across inspections. A home with a middling star and a clean recent trajectory can be a better choice than a higher-rated home sliding in the wrong direction. Put the inspection report together with what you saw on your tour and what the ratings flagged, and you'll be deciding on evidence rather than on a single number. That's the whole point of the method: the rating is a screen that tells you where to look, and by now you've done the looking.

Who Pays for a Nursing Home?

One practical thing to settle early, because it shapes your options: how the stay gets paid for. Medicare covers only short-term skilled nursing facility care after a qualifying hospital stay, up to 100 days per benefit period, and it does not pay for ongoing custodial care when help with daily activities is all that's needed. It is not a long-term nursing home benefit.

For a long-term stay, families generally rely on private pay, long-term care insurance, veterans' benefits, or Medicaid, which along with out-of-pocket spending is one of the largest payers of long-term care. This is its own topic, so rather than repeat it here, see our guides on how to pay for nursing home care and nursing home Medicaid by state.

The Bottom Line: How to Choose a Nursing Home You Trust

The honest summary is that Medicare's ratings are a good screen and a poor verdict. Used well, they let you build a shortlist fast, weight the independent inspection over the self-reported scores, and spot the homes that need a much closer look. Used lazily, taken as a single overall number, they can walk you straight into a home with a buried one-star problem.

Working through the seven steps above is what protects you from that. It's more work than glancing at a star, but it's a few hours spread over a decision that will shape a parent's daily life, and you don't have to do it alone.

Frequently Asked Questions

What should I look for when choosing a nursing home?

The four Care Compare ratings are the starting point, but the trade-off most families actually face is distance against stars. Think hard before trading proximity for half a star: a home you can reach in fifteen minutes lets you visit often, and unannounced, which is a form of oversight no rating captures. Set a radius you can realistically drive, then inside that radius weight the independent health inspection rating above the self-reported staffing and quality-measure scores, and check the Special Focus Facility list and the abuse icon before you shortlist.

What questions should I ask when touring a nursing home?

Let each home's own numbers set the agenda, then push past them. Start with staff continuity, which the staffing star already measures in part through its staff-turnover figures. Pull those up before you visit and ask the home to explain them, then ask what a count of departures can't tell you: how long have the nurses and aides on the unit your parent would live on worked here, and how long has the director of nursing been in the job? Staff continuity is what a resident meets every day. Use each home's weaker ratings to drive the rest of your questions, and try to visit around a mealtime, when staffing and dignity are both on display.

What is a Special Focus Facility?

It's a nursing home that CMS has identified as one of the poorest performers in its state, with a history of serious quality problems. These homes are inspected in person about twice as often as others and face escalating penalties, up to removal from Medicare and Medicaid, if they don't improve. There's also a larger list of "candidate" homes flagged for possible selection, so check both when you're comparing homes.

Does Medicare pay for a nursing home?

Only for short-term skilled care. After a qualifying hospital stay, Medicare covers up to 100 days per benefit period of skilled nursing care, then pays nothing. It does not cover long-term custodial care, which is what most nursing home residents need over time. For that, families use private pay, long-term care insurance, veterans' benefits, or Medicaid.

Learn More

Care TypesWhat Medicare Nursing Home Star Ratings Really MeanMedicare nursing home star ratings blend three scores, and two are self-reported. Here's how the 5-star rating is built and how much to trust it. Care TypesNursing Homes by StateWhat a nursing home costs, how Medicaid pays for it, and how facilities are rated all share a federal floor but vary by state. See yours, with a 50-state guide. FinancialHow to Pay for Nursing Home CareHow to pay for nursing home care in 2026: what it costs and how Medicaid, Medicare, VA benefits, long-term care insurance, and private pay each fit in. MedicaidNursing Home Medicaid by StateMedicaid pays for nursing-home care in every state, but the income cap, level-of-care test, and rules vary. The federal floor, what changes, and your state. Care TypesAssisted Living vs. Nursing Home by StateAssisted living is custodial care; a nursing home is 24/7 skilled care. See what each costs, who pays (Medicaid differs by state), and your state's guide.

Find personalized help comparing nursing homes and choosing the right one at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.