Using Care Compare to Check Nursing Home Quality

Choosing a nursing home is one of the most important decisions a family makes, and it often has to be made quickly. Care Compare is the federal government’s free online tool for comparing nursing homes and other providers that participate in Medicare and Medicaid. It is published by the Centers for Medicare & Medicaid Services (CMS) on the official Medicare website. This guide explains what Care Compare shows, how to read the star ratings, and how to use it alongside a visit.

Figures change periodically. Double-check current amounts before relying on them.

The short version

Care Compare covers nursing homes certified by Medicare or Medicaid, along with hospitals, home health agencies, hospice providers and others.
Each nursing home gets an overall star rating (one to five stars) based on three parts: health inspections, staffing and quality measures.
Care Compare also shows inspection reports, penalties, staffing levels and special warning flags, such as abuse icons and Special Focus Facility status.
Ratings are a starting point, not the whole story. A visit, conversations with residents and families, and a check with the long-term care ombudsman add important information.
To find it, search for “Medicare Care Compare” and use the official Medicare website.

What Care Compare shows

For each certified nursing home, Care Compare typically shows:

the overall star rating and the three component ratings;
health inspection results, including the number and seriousness of deficiencies found in recent state inspections and complaint investigations;
staffing information, such as registered nurse and total nurse staffing hours per resident per day, weekend staffing and staff turnover;
quality measures, such as rates of falls with major injury, pressure ulcers, antipsychotic medication use, hospitalizations and emergency room visits;
penalties, including fines and payment denials;
ownership information;
whether the facility participates in Medicare, Medicaid or both;
fire safety inspection results.

How the star ratings work

Health inspections

State surveyors inspect each certified nursing home about once a year on average and also investigate complaints. The health inspection rating is based on the number, scope and severity of deficiencies found over recent inspection cycles, with more weight on the most recent. This is generally considered the most important part of the rating, because it reflects on-site findings.

Staffing

The staffing rating is based on registered nurse hours and total nursing staff hours per resident per day, adjusted for how sick residents are, using payroll-based data that facilities submit. It also considers staff turnover and weekend staffing. Higher staffing is linked to better care.

Quality measures

Quality measures come from resident assessments and Medicare claims data, covering both short-stay (rehabilitation) and long-stay residents. Examples include the share of residents with new or worsening pressure ulcers, falls with major injury, or a decline in the ability to move independently.

The overall rating

The overall rating starts with the health inspection rating and then adds or subtracts stars based on staffing and quality measures. CMS updates the method from time to time.

Warning signs to look for

Abuse icon. A red icon flags facilities cited for abuse in recent inspections.
Special Focus Facility (SFF). CMS places a small number of nursing homes with a history of serious quality problems in a special program with more frequent inspections. Facilities that are candidates for the program are also listed.
Recent serious deficiencies, especially those marked as causing actual harm or immediate jeopardy.
Large fines or payment denials.
Very low staffing or high turnover.
Frequent ownership changes.

Limits of Care Compare

Care Compare is a valuable tool, but it has limits:

Some data is self-reported by facilities, and some is several months old.
Inspection results reflect specific visits and may miss day-to-day conditions.
Star ratings compare facilities within a state for inspections, so a four-star rating in one state is not directly comparable to one in another.
Ratings do not capture everything families care about, such as warmth of staff, food quality, activities or culture.
A newly opened or recently purchased facility may have limited data.

Using Care Compare with a visit

After narrowing the list with Care Compare, families should visit in person if possible, ideally more than once, including at a mealtime or in the evening. Things to notice:

Do residents look clean, dressed and engaged?
Do staff know residents by name and respond quickly to call lights?
Is the building clean and free of strong odors?
Are there activities going on?
How is the food? Are residents helped to eat when needed?
Is the administrator or director of nursing available to answer questions?
How long have key staff worked there?

Ask to see the most recent inspection report, which facilities must make available, and ask how the facility corrected any problems.

Other sources of information

State inspection reports. State survey agencies publish inspection results, sometimes with more detail than Care Compare.
Long-term care ombudsman. The ombudsman program knows local facilities and can share general information about complaints.
Hospital discharge planners and social workers who place patients regularly.
Families of current residents.

Care Compare for other services

The same tool covers home health agencies, hospice providers, inpatient rehabilitation facilities, long-term care hospitals and doctors. Families arranging care at home can use it to compare home health agencies and hospice providers. Assisted living is not covered, because it is regulated by states rather than by CMS.

Medicaid and quality

Whether a facility accepts Medicaid is shown on Care Compare. Families should confirm directly with the facility whether Medicaid beds are available and whether a resident can stay in the same bed when switching from private pay. See Getting into a Medicaid nursing home.

A simple example

Carol’s father needs a nursing home near her home. She searches Care Compare by ZIP code and finds eight facilities that accept Medicaid. Two have abuse icons, and one is a Special Focus Facility candidate. She narrows the list to three with at least three stars overall and good staffing ratings. She visits all three, talks with residents’ families in the lobby, and asks the ombudsman whether there are concerns. She chooses the facility with the best staffing and a friendly, stable team, even though it is a few miles farther away.

Getting help

The long-term care ombudsman program can help families understand inspection results and residents’ rights. A Certified Medicaid Planner can help with the financial side, so the family can focus on choosing a good facility.

Frequently asked questions

Is Care Compare free? Yes. It is a free public tool on the official Medicare website.

How often is it updated? Data is refreshed regularly, generally monthly or quarterly, depending on the measure.

Should I rule out a facility with low stars? Not automatically, but look closely at why. Serious recent deficiencies are a stronger warning than an older, minor problem.

Does Care Compare include assisted living? No. Assisted living is licensed by states, and some states publish their own inspection reports.

Key terms

Deficiency (citation): a problem found during an inspection that does not meet federal standards.
Scope and severity: how widespread a deficiency is and how much harm it caused or could cause.
Quality measures: data on resident outcomes, such as falls and pressure ulcers.
Special Focus Facility: a nursing home with a history of serious problems that is inspected more often.

A step-by-step way to use the ratings

Search by city or ZIP code and filter to facilities that accept Medicaid.
Remove any with an abuse icon or Special Focus status, unless there is a strong reason to keep them.
Compare health inspection and staffing stars, which tend to matter most day to day.
Open the inspection report for each finalist and read the most serious findings.
Visit the finalists and talk with the ombudsman.
Make a choice, and keep checking ratings after admission.

Questions to ask the facility about its ratings

What were the most recent inspection findings, and how were they fixed?
How has staffing changed over the past year?
What is the turnover among nurses and aides?
Who is the administrator, and how long have they been there?

After admission

Ratings can change. Families can keep checking Care Compare every few months, read new inspection reports, and raise concerns with the administrator or ombudsman if care slips.

Ratings for short-stay rehabilitation

Care Compare reports some quality measures separately for short-stay residents, such as people recovering from surgery, and long-stay residents. A family choosing a facility for rehabilitation after a hospital stay should look at short-stay measures, such as the share of residents who return home successfully and the rate of rehospitalization. A family choosing a long-term home should focus on long-stay measures, such as falls, pressure ulcers, weight loss and antipsychotic use. A facility can do well on one and poorly on the other.

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.