five wooden blocks with yellow stars

How The CMS Rating System Ranks Skilled Nursing Care

You may have heard of the Centers for Medicare & Medicaid Services (CMS) star rating in reference to skilled nursing care – but what does it actually mean? The distinguished 1- to 5-Star rating system helps consumers make meaningful distinctions between high-performing and low-performing skilled nursing care, both in senior living communities and in stand-alone skilled nursing homes, and to help these senior care providers identify areas for improvement. This rating system shows how well a skilled nursing facility caters to their resident’s physical and clinical needs.

How Ratings Are Determined

CMS assesses three key categories of a skilled nursing facility to determine its rating – health inspections, staffing and quality measures. The overall star rating is a composite of the three individual categories. The health inspection rating is the most influential category, which is adjusted up if the care center receives very high staffing or quality measure ratings, and is adjusted down for low staffing or quality measure ratings.

Health Inspection Rating

Once a year, CMS performs an unannounced, comprehensive inspection of a skilled nursing facility. The care center is rated on a point system tallying the number, scope, and severity of deficiencies during the most recent 36 months, and any repeat visits needed to verify corrections. The skilled nursing provider is also rated on a set of standard surveys and complaint surveys. Essentially, the more points a skilled nursing provider is given for each of the criteria, the worse rating it receives, with the goal being 0 points. Here’s a quick breakdown of the CMS point health inspection point system:

  • 50-175 points: Immediate jeopardy to resident health or safety
  • 20-45 points: Actual harm that is not immediate jeopardy
  •  4-16 points: No actual harm but there is potential for more than minimal harm
  • 0 points: No actual harm with potential for minimal harm

Staffing Rating

The staffing rating examines the number of hours of care provided on average to each skilled nursing resident by nursing staff. The CMS Staffing Study has correlated a distinct association between nurse staffing ratios and quality of care. The higher the ratio, the better resident outcomes tend to be. The rating is based on two staffing measurements:

  • Total nursing hours per resident per day (including RNs, LPNs and CNAs
  • RN hours per resident per day

In their staffing measurements, CMS  includes full-time and part-time employees employed directly by the care center, as well as staff hired through an outside organization working under contract. The staffing star rating is assigned based on the combination of the individual RN and total staffing star ratings, with each receiving equal weight. To receive a 5-Star rating, skilled nursing care centers must achieve a 5-Star  rating on both RN hours per resident and total staffing.

Quality Measurement Rating

Quality measures (QMs) are indicators describing the status of a broad range of care areas. Recently, CMS has amended its QM process to score long-term care and short-term care individually. Unlike the health inspection and staffing rating, QMs are measured in percentages. Each QM factors what percentage of the total number of residents meet the specific QM goal. For example:

  • Percentage of short-stay residents who improved in their ability to move around on their own
  • Percentage of short-stay residents who were rehospitalized after a nursing home admission
  • Percentage of long-stay residents experiencing one or more falls with major injury
  • Percentage of long-stay residents who have symptoms of depression

A full list of QMs are available on the CMS website. The most important takeaway is that these measures assess residents’ physical and clinical conditions and abilities, as well as preferences and care wishes, to give consumers a clearer picture of both resident outcomes and quality of care while they’re in a skilled nursing facility.

How Overall Quality Score Is Determined

The CMS 5-Star quality rating system has developed a refined process to determine the rating of any given nursing home and skilled nursing facility. After all three categories have been rated, CMS uses the following formula to determine an overall rating:

  1. Start with the health inspection 5-Star rating.
  2. Add one star to Step 1 if staffing rating is four or five stars and greater than the health inspection rating. Subtract one star if staffing is one star.
  3. Add one star to Step 2 if quality measure rating is five stars. Subtract one star if quality measure rating is one star.
  4. If the health inspection rating is one star, the overall quality rating can’t be upgraded by more than one star based on the staffing and quality measures.
  5. If the care center is a Special Focus Facility (SFF) that hasn’t graduated, the maximum overall quality rating is three stars.

Why a 5-Star Rating Should Matter to You

Skilled nursing centers with 4 to 5 stars are considered to have  much above average quality care, and those with 1 star are considered to have care quality that is much below average. The overall rating offers valuable insight into the quality of care provided in any given skilled nursing facility without bias. The 5-Star quality rating system is based on hard data without any preferential treatment or influence. It’s a truly objective source of information for those in search of the right care. And while the overall rating is important, it can be even more helpful to make an informed decision about a senior living community by looking at each category’s rating and the reasons behind it. All his information and more can be found on the Nursing Home Compare website from, which includes important information from more than 15,000 nursing homes and senior living communities in the country.

5-Star Skilled Nursing at The Buckingham

Here at The Buckingham, we’re proud to be among the few providers of skilled nursing Houston has to offer with a 5-Star overall rating. While CMS frequently changes ratings based on new inspections and information, we’re proud to be a leader in quality senior care. It’s a testament to our entire staff’s continued devotion to providing the highest-quality care to every one of our skilled nursing residents. On top of the premier services, amenities and residences we offer, it’s our dedicated team who make The Buckingham a phenomenal place to live. If you’d like to learn more about our community or our 5-Star skilled nursing care, contact us through our website or call us anytime at 713-979-3090.