About the Data
CareRatingHub uses official data from the CMS Provider Data Catalog (data.cms.gov), maintained by the Centers for Medicare & Medicaid Services — the U.S. government agency that oversees Medicare. This is the same data used to generate the star ratings displayed on Medicare's own Care Compare website.
Staffing numbers come from Payroll Based Journal (PBJ) submissions — actual payroll records that nursing homes are required to submit electronically to CMS. This replaced the older system of self-reported staffing surveys, making the data significantly more reliable. CMS uses this data to calculate case-mix adjusted staffing expectations based on each facility's patient acuity.
Inspection deficiencies, fines, and penalty data come from CMS health inspection surveys conducted by state agencies. CMS updates all datasets quarterly. CareRatingHub is independently operated and is not affiliated with or endorsed by CMS, Medicare, or any nursing facility.
Understanding the CMS 5-Star Rating
The CMS 5-star rating is the most widely cited measure of nursing home quality — but it doesn't tell the full story. Here's how it actually works and what to watch for.
Three Ratings Become One
The overall star rating is a composite of three separate component ratings:
Health Inspections
Based on on-site state surveys over the last 3 inspection cycles (~3 years). Measures deficiency count, severity, and scope. This is the most heavily weighted component.
Staffing
RN, LPN, CNA, and PT hours per resident per day, drawn from Payroll Based Journal (PBJ) records — actual payroll data, not self-reported surveys.
Quality Measures
15+ clinical metrics like falls, pressure ulcers, UTIs, weight loss, and ER visits. These are largely self-reported by facilities through MDS assessments.
Why a 5-Star Rating Can Be Misleading
A 5-star rating doesn't mean "excellent" in absolute terms — it means the facility is in roughly the top 20% relative to other facilities. The system uses a distribution curve, so when some facilities drop, others automatically rise. Here's what that means in practice:
- Quality Measures are gameable. Since they're based on how facilities document patient conditions, the way a facility codes its MDS assessments directly impacts its score. Better documentation practices can improve quality ratings without any change in actual care.
- Inspection timing matters. Health inspection ratings use the last 3 cycles. If a facility had a bad survey 3 years ago, that drops off — even if underlying issues haven't been resolved.
- The overall rating isn't a simple average. CMS applies a formula that starts with the health inspection rating and adjusts up or down based on staffing and quality measures. A facility with excellent QMs can offset a mediocre inspection rating.
- Staffing ratings can mask daily shortfalls. A facility might have adequate average staffing but consistently run short on weekends or night shifts. The star rating doesn't capture shift-level variation.
What CareRatingHub Adds
This is exactly why CareRatingHub goes beyond star ratings. The PBJ staffing gap shows you whether a facility is actually meeting its staffing needs based on patient acuity — translated into real shifts per day so you can see the practical impact. A 5-star facility that's consistently 2-3 nursing shifts short every day is a very different picture than what the star rating alone suggests.
Our recommendation: Use the star rating as a starting point, not a final answer. Look at the staffing gap data, inspection deficiency details, and penalty history to get the full picture before choosing a facility for your loved one.
Frequently Asked Questions
What is CareRatingHub?
CareRatingHub is a free tool that helps families research nursing homes using official data from the Centers for Medicare & Medicaid Services (CMS). It shows star ratings, real staffing levels from payroll records, inspection deficiencies, fines, regulatory risk, and ownership information for over 15,000 Medicare-certified skilled nursing facilities across all 50 states.
Where does the data come from?
All data comes from the CMS Provider Data Catalog (data.cms.gov), a public dataset maintained by the U.S. government. Staffing data is based on Payroll Based Journal (PBJ) submissions — actual payroll records, not self-reported surveys. CMS updates this data quarterly.
What is a PBJ staffing gap?
A PBJ staffing gap is the difference between a nursing home's actual staffing hours per resident per day (from payroll records) and the hours CMS calculates the facility should provide based on patient acuity (case-mix adjusted). A negative gap means the facility is understaffed relative to patient needs. CareRatingHub translates these gaps into estimated shifts per day so you can understand the practical impact.
What does the CMS 5-star rating mean?
CMS assigns nursing homes a 1-to-5 star rating based on three components: Health Inspections (on-site surveys, most heavily weighted), Staffing (nurse hours from payroll records), and Quality Measures (clinical outcomes, largely self-reported). A 5-star rating means the facility is in roughly the top 20% relative to other facilities — it's a curve, not an absolute standard. Quality Measures can be influenced by how a facility documents patient conditions, and the overall score uses a formula that can offset weaknesses in one area with strengths in another. Use star ratings as a starting point, then look at staffing gaps and inspection details for the full picture.
Can a 5-star facility still be understaffed?
Yes. The star rating reflects an overall composite score, and strong Quality Measure or inspection ratings can compensate for lower staffing numbers. Additionally, staffing ratings are based on averages — a facility may meet its average target while running short on nights, weekends, or specific shifts. CareRatingHub's PBJ staffing gap data shows the difference between actual payroll-verified staffing and what CMS calculates the facility needs based on patient acuity. A 5-star facility that's consistently multiple nursing shifts short every day tells a very different story than the star rating alone.
What is a Special Focus Facility (SFF)?
A Special Focus Facility is a nursing home that CMS has identified as having a persistent record of poor care. SFFs receive more frequent inspections and must show improvement or face penalties including termination from Medicare. CareRatingHub flags SFF status prominently in each facility's regulatory risk section.
Does CareRatingHub include assisted living facilities?
No. CareRatingHub covers Medicare-certified skilled nursing facilities (SNFs) only — approximately 15,000 facilities nationwide. Assisted living and memory care facilities are regulated at the state level and are not included in the federal CMS dataset.