Nursing Home Staffing Ratings Across the U.S.

The two domains grounded in outside verification — the on-site health inspection and staffing, which CMS derives from submitted payroll data — average lowest. The quality-measure domain, which draws substantially on facility-reported assessment data, averages highest. That ordering is why the overall star can sit above what a family would infer from the inspection and staffing records alone.

Among the 14,433 fully-rated facilities, 1,284 (8.9%) hold a 4- or 5-star overall rating while holding a 1- or 2-star staffing rating. That is roughly one in 11 highly-rated facilities.

This is not evidence of poor care, and it is not evidence that CMS is wrong. The overall star is a composite and is designed to blend domains; a facility can score well on measured resident outcomes while reporting fewer staffing hours per resident day than its peers. The practical point is narrower: the headline star does not tell you the staffing story, and the staffing star is published separately for exactly that reason. Every facility page on this site shows all four domains together.

• Staffing stars are relative, not absolute. CMS assigns them by comparing a facility’s reported staffing hours per resident day against national distributions. A 1-star staffing rating means low relative to peers, not a specific hours figure.
• Staffing levels change. The rating reflects a past reporting period. A facility that has recently hired, or recently lost staff, will not show it yet.
• Case mix matters. Facilities serving residents with heavier care needs require more staffing to achieve the same rating; CMS adjusts for this, but no adjustment is perfect.
• This is not a ranking. These are distributions across the country. They say nothing about any individual facility, and SeniorCareRating.com does not rate or recommend providers.

One email covering what changed in the public CMS record: dataset releases and what moved in them, additions to and departures from the Special Focus Facility list, and any new analysis published here. Written for people who work with this data. Roughly monthly.

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• How CMS rates the nation's nursing homesThe overall star distribution and how it diverges from inspections→
• Federal penalties in CMS nursing-home dataHow often fines and payment denials appear in the record→
• How to check a nursing homeReading all four CMS domains together, step by step→
• Compare nursing homesPut facilities side by side, staffing star included→
• Search nursing homesFilter by CMS rating, staffing, penalties, and ownership→