Medicare gives each certified nursing home an overall rating of 1 to 5 stars (1 = much below average, 3 = average, 5 = much above average) built from three parts: health inspections, staffing and quality measures. Use the stars to narrow your list and to know what to ask, not as a final answer.
Who this is for
Families comparing nursing homes for a parent or partner, and anyone reading a CaringBloom facility page who wants to know what the numbers mean.
The three parts
| Rating | What it is based on | Where to look on CaringBloom |
|---|---|---|
| Health inspections | State inspectors' findings from yearly standard inspections, complaint inspections and infection-control inspections. | “Inspections and penalties” on each facility page |
| Staffing | Hours worked by nursing staff per resident per day (from payroll data the home reports) and staff turnover. | “Staffing” section, with NH averages |
| Quality measures | Clinical measures for short-stay and long-stay residents, such as falls with injury, pressure ulcers, antipsychotic use and vaccinations. | “Quality measures” section |
Medicare notes that nurse staff hours per resident per day describe the average time staff are available, not how many staff are on duty at a given time; higher is better when comparing homes. For turnover, lower is better.
What the stars don't tell you
CMS cautions that no rating system covers everything, for example specialty rehab or dementia care, or how easy it is for family to visit. A closer home that family can visit often may be a better choice than a higher-rated one far away. CMS recommends combining the ratings with a visit and with state or local organizations such as the Long-Term Care Ombudsman.
Homes that aren't rated
Some homes show no stars. Common reasons in the CMS data are being newly certified, too little data, or being a Special Focus Facility (SFF), a CMS program for homes with a history of serious quality issues. SFF homes are inspected more often. Medicare also shows an abuse icon next to homes cited for abuse-related problems.
New Hampshire at a glance
In the CMS file dated Oct 1, 2026, New Hampshire's 73 certified nursing homes break down as: 14 with 5 stars, 17 with 4 stars, 13 with 3 stars, 13 with 2 stars, 15 with 1 star, and 1 not rated. 6 NH homes are in the SFF program or listed as candidates.
Questions to ask
- Your staffing rating is X: how many residents does each aide care for on days, nights and weekends?
- What happened in your most recent inspection, and what did you change?
- Which quality measures are you working to improve?
This guide is general information, not medical, legal or financial advice. For decisions about your situation, talk with your doctor, the hospital or facility social worker, an Aging & Disability Resource Center, or an elder-law attorney.
Official sources
- CMS: Five-Star Quality Rating System
- Medicare: Your Guide to Choosing a Nursing Home (PDF)
- CMS Provider Information dataset
- Medicare Care Compare
Sources checked Nov 11, 2026. Rules and dollar amounts change, usually each January; confirm with the source.