How CMS Rates Nursing Homes vs. Home Health
Both nursing homes and home health agencies get a CMS five-star rating, so it is tempting to treat the two numbers as the same currency. They are not. This explains what each system measures, how coverage differs, and why the stars do not convert one-for-one.
The short version
What each rating actually measures
Nursing homes. The overall five-star rating combines a health-inspection rating (from on-site surveys and complaint investigations), a staffing rating (nurse hours per resident, case-mix adjusted), and a quality-measures rating (clinical outcomes for long- and short-stay residents). The inspection domain anchors it, with staffing and quality able to move it up or down.
Home health agencies. The quality-of-patient-care star summarizes a set of process and outcome measures — how often patients improved at walking, getting in and out of bed, managing medications, and similar — for care delivered at home. There is no on-site building inspection equivalent, because there is no facility to inspect; oversight and the measure set are simply different.
The two distributions, side by side
Nursing homes — CMS overall star
Distribution across rated nursing homes.
CMS-reported data · site-calculated context, not a CMS rating
Home health — quality-of-patient-care star
Distribution across rated agencies, at the half-star resolution CMS publishes.
CMS-reported data · site-calculated context, not a CMS rating
These are two scales, not one: nursing homes in whole stars, home health in the half stars CMS actually publishes. Comparing the shapes is informative, but a three-star nursing home and a three-star agency are not equivalent, and this site never combines the two systems into a single score or ranking.
Why you cannot convert one to the other
Three reasons the stars are not interchangeable.
- Different inputs. Inspections and staffing drive the nursing-home star; neither exists in the home health measure set.
- Different coverage. Almost all nursing homes are rated; a meaningful share of home health agencies are not, so a missing home-health star is common and not a negative.
- Different care. One rates a 24-hour residential facility; the other rates episodic care delivered in someone’s home. A family choosing between settings should read them as separate evidence, not a single ranking.
If you are comparing providers within a setting, the stars are useful. Across settings, use them as context alongside the underlying records. Our companion reports break down each system on its own terms.
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