What Medicare star ratings mean for home health, hospice and nursing homes

Medicare's star ratings compare care providers on Care Compare. Nursing homes and home health agencies get 1 to 5 stars, and hospice quality is published as measures. Each is a useful input and none replaces a visit and questions.

These ratings are about providers of care. They are not the star ratings Medicare gives its health and drug plans, which are a separate system we do not cover here.

Nursing homes: the Five-Star system

CMS gives every nursing home one overall rating from 1 to 5 stars. Five stars means much above average quality, and one star means much below average. There are also separate ratings for three parts:

• Health inspections
• Staffing
• Quality measures

The CMS page we read says the overall rating is explained in the Five-Star Technical Users' Guide, which we did not summarize. It lists dated changes: staff turnover and weekend staffing measures were added to Care Compare in January 2022 and used in the star ratings from July 2022, and in January 2023 CMS said it would audit schizophrenia coding in Minimum Data Set data and adjust quality ratings for facilities with inaccurate coding.

The limits CMS states

• No rating system can address all of the important considerations in choosing a nursing home.
• Specialty care, such as rehabilitation or dementia care, and how easily family can visit are not captured.
• A nearby home may be better than a higher-rated home that is far away, because visits can improve quality of life and care.
• CMS advises using the ratings with other sources, including a visit to the facility and state or local organizations such as the State Ombudsman program.

See nursing homes near you, and how assisted living compares with a nursing home.

Home health agencies: two ratings

CMS publishes two separate star ratings for home health agencies, both updated quarterly on Care Compare.

	Quality of patient care	Patient survey
What it uses	Patient assessments (OASIS) and Medicare claims	The Home Health CAHPS survey
What it covers	Seven measures: timely start of care, improvement in walking, bed transferring, bathing, shortness of breath, taking oral medicines, and potentially preventable hospitalizations	Care of patients, communication between providers and patients, specific care issues and an overall rating of care
Minimum for a rating	At least 20 complete episodes or stays per measure, and data on at least 5 of the 7 measures	At least 40 completed surveys over four quarters

Some details from CMS:

• The patient survey rating leaves out the "willingness to recommend" question, because its results closely track the overall rating.
• Agencies see their results in a preview report before they are posted and have time to ask for a review of errors: about 3.5 months ahead for the quality rating and about one month ahead for the survey rating.
• Starting July 1, 2025, agencies must submit assessment data for all patients regardless of payer, but the assessment-based measures are calculated only for Medicare fee-for-service, Medicare Advantage, Medicaid and Medicaid managed care patients.

An agency that does not meet the minimum gets no star rating, and its survey data may still be reported. CMS says the ratings are intended as one tool among several for choosing a provider. CMS also says it will refine the ratings over time.

If you are choosing an agency, use these alongside the checklist in how to choose a home care agency.

Hospice: measures, not a single score

The CMS page we read does not describe a single overall hospice star rating. It says Care Compare is the official CMS site for publicly reporting hospice quality measures, and that CMS's Hospice Quality Reporting Program uses three data sources: assessments hospices submit, Medicare hospice claims and the CAHPS Hospice Survey.

CMS describes the program as pay-for-reporting. A hospice that does not submit complete data on time faces a payment penalty, and performance is not a factor in the annual payment update. So a publicly reported result does not tell you that a hospice met a performance standard for payment. The data can be downloaded from the CMS Provider Data Catalog.

For what hospice care is and how Medicare pays, see hospice vs palliative care and hospice care.

How Carevo uses the ratings

Carevo shows the rating CMS publishes and does not make its own. Where CMS publishes more than one rating for a kind of provider, our listings say which one we use. A provider with no CMS rating has not been judged poor. It has not been rated. Our methodology explains the details, and Medicare care ratings by state summarizes how states compare on CMS's own data.

A short checklist for using star ratings

1. Look at the parts, not only the overall number. For a nursing home, read the inspection, staffing and quality ratings.
2. Check whether a missing rating means no data. An unrated provider is not a poor one.
3. Visit, and ask the questions the ratings cannot answer: specialty care, visiting, staff you meet.
4. Use the State Ombudsman program for nursing homes, as CMS suggests.
5. Compare more than one provider, and ask for costs in writing. The care cost comparison helps put quotes side by side.

Carevo does not vouch for any provider, and a star rating is not a recommendation.