Nursing Homes: Medicare Ratings, Inspections and Staffing by State
Data from Medicare (CMS Care Compare). hclin is not affiliated with Medicare or CMS. Ratings and inspection results change every month; confirm details with each facility and with Medicare before making a decision. This page is informational and is not medical, legal or financial advice.
Medicare certifies 14,690 nursing homes in the U.S. and rates each one from 1 to 5 stars using state inspections, nurse staffing and quality measures. The national average is 3.0 stars; 20% of homes hold 5 stars and 21% hold 1 star. This guide explains the ratings and links to a report for every home.
How does Medicare rate nursing homes?
Medicare gives every certified nursing home an overall rating from 1 to 5 stars that starts from its health inspection score and moves up or down with its staffing and quality-of-care scores.
The inspection score comes from state surveyors who visit unannounced; staffing comes from payroll data the home submits; quality measures come mostly from resident assessments the home reports itself. That is why families who read the inspection record usually learn more than those who stop at the overall stars. Nationally, the ratings are spread across the scale:
| Overall rating | Share of U.S. nursing homes |
|---|---|
| ★★★★★ | 20% |
| ★★★★★ | 19% |
| ★★★★★ | 19% |
| ★★★★★ | 20% |
| ★★★★★ | 21% |
Which states have the best-rated nursing homes?
Hawaii (3.6), Alaska (3.5) and Arkansas (3.4) have the highest average Medicare ratings, while Missouri (2.5), Louisiana (2.5) and Illinois (2.5) have the lowest; sort the table by any column to compare.
States with a detailed guide are linked. New state guides are added as the directory grows.
What do nursing home inspectors cite most often?
Infection control, accident hazards and kitchen food safety are the three most frequent citations in Medicare's current data, which holds 419,479 health citations; 5.5% of them were rated as actual harm or immediate jeopardy.
| Tag | What it covers | Citations |
|---|---|---|
| F0880 | Infection prevention, from handwashing to isolation and outbreak control | 24,240 |
| F0689 | Keeping the building free of accident hazards and supervising residents at risk of falls | 21,413 |
| F0812 | Storing, preparing and serving food under sanitary conditions | 20,020 |
| F0684 | Following doctors' orders and each resident's care plan | 16,469 |
| F0656 | Writing a complete care plan with measurable goals for every resident | 14,681 |
| F0761 | Storing and labeling medications correctly | 13,677 |
| F0677 | Helping residents who cannot bathe, eat or use the toilet on their own | 10,172 |
| F0695 | Other requirement | 9,507 |
Each home's page in this directory lists its own citations with the date, the official wording and the severity, so you can see whether a problem was a one-off or a pattern.
How many nurse hours should a nursing home provide?
U.S. nursing homes report 3.9 hours of nursing care per resident per day on average, of which 0.7 come from registered nurses; homes well below that level tend to score 1 or 2 stars on staffing.
Turnover matters as much as hours. The national average for nursing staff is 46% a year, meaning roughly half of the caregivers change every year in a typical home.
How do you choose a nursing home with this directory?
Start with the state or city guide, shortlist three homes with good inspection scores, then open each home's report and tour with the questions it lists.
- Pick your state and city guide to see every Medicare-certified home ranked and mapped.
- Filter by Medicaid if you will need it, and hide homes with an abuse flag.
- Compare inspection scores and nurse hours before the overall stars.
- Open each shortlisted home's report and read its citations from the last three years.
- Visit twice, once on a weekend, with the tour questions from the report.
Frequently asked questions
How are nursing homes rated by Medicare?
Medicare's overall rating starts from the health inspection rating, set by state surveyors, and moves up or down based on nurse staffing and quality measures. Each part is also shown as its own 1 to 5 star score.
What is the difference between a nursing home and a skilled nursing facility?
In Medicare's data they are the same certified facilities: a skilled nursing facility is the Medicare term for short-term rehab after a hospital stay, while nursing home usually refers to long-term care in the same building.
How often are nursing homes inspected?
State surveyors carry out a standard inspection roughly every 12 to 15 months and investigate complaints in between; 31% of the citations in Medicare's current data came from complaint investigations.
Does Medicare pay for a nursing home?
Medicare covers short-term skilled nursing and rehab after a qualifying hospital stay, for a limited number of days. Long-term custodial care is usually paid privately or by Medicaid once savings are spent down.
Compiled by Elvis, data editor at hclin. Data from the Centers for Medicare & Medicaid Services (CMS); sources below.
Sources:
- CMS Provider Data Catalog, "Nursing Homes Including Rehab Services: Provider Information" (August 2026 release). data.cms.gov
- CMS Provider Data Catalog, "Health Deficiencies" (August 2026 release). data.cms.gov
- CMS, "Nursing Home Data Dictionary" (February 2026). PDF
How we rank: Medicare overall star rating first, then the health inspection rating, then the weighted health inspection score (fewer and less severe citations rank higher). No facility pays to appear or to be ranked. Full methodology and corrections policy.