Health and Wellness: How to Choose the Best Skilled Nursing Facility


Imagine it’s 2007, and you are looking for a skilled nursing facility for your grandfather. After searching the World Wide Web, you find some charts with rows and rows and columns and columns of data. The data seems important, but what does it mean? It’s way too complicated to interpret.

That’s why, in 2008, the Centers for Medicaid Services created a rating system to make it simple. Facilities can earn up to five stars in three categories. It’s much easier to make a data-based decision now! Read on to learn how to use this system to choose a skilled nursing facility for your loved one.

What Does a Five-Star Rating Mean?

Skilled nursing facilities can earn up to five stars in three categories: health inspections, quality measure ratings, and staffing ratings. These ratings combine to form an overall rating out of five stars. But what do those stars really mean? Let’s dive in.

Health Inspection Ratings: Trained inspectors visit the skilled nursing facility and conduct a survey to determine how well the facility meets the Department of Health’s expectations. The scores from the last three years are considered in the final score. Here’s how the scores break down:

  • Five stars: The top 10 percent of skilled nursing facilities
  • One star: The bottom 20 percent of skilled nursing facilities
  • Two to four stars: The middle 70 percent (with 23.33 percent of skilled nursing facilities in each category)

“For people looking for a skilled nursing facility for their loved one, the health inspection is the main test the building needs to pass to show they truly are performing above the standards,” says Wendy Haining, education and development manager at Generations Healthcare, a company whose 27 facilities all ranked highly in 2021. “The overall star rating starts with health inspection. You can’t earn five stars overall unless you earn at least a three on your health inspection.”

Quality Measure Ratings: The quality measure rating reflects how well a facility cares for its residents’ physical and clinical needs in 15 different quality measures. Some of these measures include the following:

  • Re-hospitalization rate
  • Emergency room placements
  • Percent needing antipsychotic medication when they weren’t taking it before
  • New or worsening pressure ulcers
  • Independence of mobility
  • Rate of successful transition back home
  • Increased need for help with activities of daily living
  • Falls

The quality measures benchmarks are chosen by CMS as areas each facility should be focusing on. If a facility only earned three stars on its health inspection and it earned five stars for quality measures, that would bump its overall rating up to four stars.

Staffing Ratings: How many hours of care does each resident receive each day from nursing staff? The staffing rating answers this question, taking into account differences in the levels of care residents need in each skilled nursing facility. For example, a skilled nursing facility caring for residents with more severe needs is expected to have a higher nurse-to-patient ratio than a facility whose residents had less severe needs.

“No one wants to come to a facility if they don’t think there’s adequate care from employees!” Haining says. “The staff rating can help families feel comfortable that their loved one will receive the nursing care they need.”

If a facility earns three stars for its health inspection but earns four or five stars on its staffing, that will increase the overall rating up to four stars.

Overall, the CMS ratings reflect the compassionate efforts of individual employees coming together to form a safe, healing environment for residents.

How Care Compare Helps You Choose

You can use CMS’s Care Compare tool to see the ratings of the skilled nursing facilities you’re considering, side by side. Below is an example comparing three skilled nursing facilities in the Huntington Beach, California, area: Generations Healthcare’s Newport Nursing and Rehabilitation Center and two other local facilities.

The chart makes it so simple to see how well these facilities rate on the factors that matter to you. And if you keep scrolling, you’ll see more interesting data.

The CMS rating system also encourages the skilled nursing facilities themselves to improve.

“The CMS ratings help us make sure our clinical practices and processes are continuously improving and give us opportunities to give the best clinical care,” Haining says. “They enable us to better help teams identify focus areas to improve overall care to the patients. They’re a valuable tool.”

Choosing a skilled nursing facility is a hard decision, but the Care Compare tool makes it a little easier. Knowing the health inspection, quality measures, and staffing ratings of the facility you choose can help you rest easy as you send your loved one there for care. So head over to Care Compare to do a little research, and find a facility in your area for skilled nursing care you can trust.

A version of this article was published by The Daily Herald. It has been republished here with permission.


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