CMS star ratings explained: what each care star really measures
Published August 7, 2026 · Last updated August 7, 2026
Start with the right star
CMS uses stars to summarize different kinds of information. The care setting changes what a star can tell you. It does not replace a call or a visit. Use it to choose better questions.
| Care setting | Star to use | What it summarizes |
|---|---|---|
| Nursing home | Overall Five-Star rating | Health inspections, staffing, and quality measures |
| Home health agency | Quality of Patient Care star | OASIS assessments and Medicare claims data |
| Home health agency | Patient Survey star | Patient experience reported through HHCAHPS |
| Hospice | Family caregiver survey rating | Family caregiver experiences reported through CAHPS Hospice |
CMS and Medicare.gov describe these rating systems in the sources linked below. They are separate systems, not one common score.
Nursing home stars combine three areas
Nursing homes have one CMS Overall Five-Star rating. It starts with the health inspection rating. CMS then adjusts it for staffing and quality measures. The three separate ratings remain worth reading.
Health inspections look at deficiencies from surveys and complaints. Staffing includes nursing hours and staff turnover. Quality measures use resident assessment and claims information.
Source: CMS, Nursing Home Five-Star Quality Rating System technical guide, read 2026-08-07.
Home health has two separate stars
Home health agencies can have two different CMS star ratings. They answer different questions. Do not combine them into one score.
| Home health star | What CMS uses | Best use |
|---|---|---|
| Quality of Patient Care | OASIS assessments and Medicare claims data | Compare care processes and outcomes |
| Patient Survey | HHCAHPS patient surveys | Compare reported patient experience |
CMS says the Quality of Patient Care star needs enough data across the measures it uses. The survey star needs enough completed surveys.
Source: CMS, Home Health Star Ratings, read 2026-08-07.
Hospice has a family survey star
Hospice does not have one CMS overall star. Its star is the Family caregiver survey rating. It reflects family caregiver reports about hospice care. It does not combine inspections, staffing, and quality measures.
The survey covers communication, timely help, respect, and support. It also covers help for pain and symptoms. Families report an overall hospice rating and willingness to recommend.
Source: Medicare.gov, Family caregiver survey rating for hospice agencies, read 2026-08-07.
Source: CMS, CAHPS Hospice Survey, read 2026-08-07.
How common each nursing home star is
Our table counts the CMS nursing home records in our current release. It shows why you should look beyond one star alone.
| Nursing home overall rating | Records in our CMS copy |
|---|---|
| All nursing home records | 14,690 |
| 1-star overall rating | 3,015 |
| 2-star overall rating | 2,962 |
| 3-star overall rating | 2,820 |
| 4-star overall rating | 2,785 |
| 5-star overall rating | 2,981 |
| No published overall rating | 127 |
Read at page-render time from our copy of the CMS release. The counts change when CMS republishes.
How often home health quality stars are missing
A missing Quality of Patient Care star is common. It is not a failing grade. CMS may not have enough measure data to calculate it.
| Home health Quality of Patient Care star | Records in our CMS copy |
|---|---|
| All home health agencies | 12,460 |
| No published quality star | 4,410 (35.4%) |
| Published quality star | 8,050 |
| Published 5-star quality rating | 477 |
Percentages are calculated when this page renders from counts in our current CMS copy.
How often hospice survey stars are missing
A missing hospice survey star is even more common. Medicare.gov says it can mean too few surveys. It does not mean the hospice did something wrong.
| Hospice Family caregiver survey rating | Records in our CMS copy |
|---|---|
| All hospice summary-rating records | 6,669 |
| No published family survey star | 4,505 (67.6%) |
| Published family survey star | 2,164 |
| Published 5-star family survey rating | 417 |
Percentages are calculated when this page renders from counts in our current CMS copy.
What a missing star means
A missing star is missing information, not a bad grade. New providers may not have enough data yet. Small samples can also prevent a CMS star. Ask the provider why no star is shown.
Then compare the information CMS does publish. Check services, location, survey results, and inspection details. Ask your care team which needs matter most.
What to do when stars disagree
Different stars can point in different directions. That is a reason to read the details. For nursing homes, open the inspection, staffing, and quality ratings. For home health, look at both stars separately. For hospice, use the family survey star as one part of your review.
A high survey star does not answer every care question. A high quality star does not replace a family conversation. Ask how the provider handles your specific needs.
Use stars before you call
Make a short list before you contact providers. Use the star that matches the care setting. Then ask the same questions of each provider.
- Do you serve my ZIP code?
- Can you meet the care needs we have now?
- Who will answer after hours?
- What should our family expect in the first week?
- Why is a CMS star missing or different from another star?
We use CMS data only. No provider can pay to change a CMS rating. Advertising is a flat monthly fee and is clearly labeled. It never changes ratings or search order.
- Compare home health agencies by state
- Compare hospices by state
- Compare nursing homes by state
- Read our rating methodology
What this guide cannot decide
This guide explains public CMS ratings. It does not decide which care is right for someone. That choice belongs to the patient, family, and care team. Use ratings as one tool in a larger conversation.
Questions families ask
What does a nursing home overall star measure?
It summarizes health inspections, staffing, and quality measures. CMS starts with the health inspection rating. CMS then adjusts for staffing and quality measures.
Are home health quality and survey stars the same?
No. The Quality of Patient Care star uses OASIS assessments and Medicare claims data. The Patient Survey star uses HHCAHPS patient surveys.
Does hospice have an overall CMS star rating?
No. Hospice has a Family caregiver survey rating. It summarizes family caregiver experiences from the CAHPS Hospice survey.
Does no star mean a provider is bad?
No. A missing star usually means CMS lacks enough data to calculate it. It can happen when too few surveys are available.
How many home health agencies have no quality star?
Our current CMS copy has 4,410 agencies without a published quality star. That is 35.4% of agencies in our copy.
How many hospices have no family survey star?
Our current CMS copy has 4,505 hospices without a published family survey star. That is 67.6% of hospice summary-rating records in our copy.