Illinois Nursing Home Star Ratings: What Do They Tell You?

Last Updated: September 14, 2026

A nursing home’s star rating is a federal comparison tool built from inspection results, staffing data and quality measures. The health inspection stars are graded against other facilities in the same state, so about the same share of Illinois homes lands in each band from month to month by design. Read the facility’s own inspection reports, then visit.

Does a low star rating mean a nursing home gives poor care?

“The place we picked for Dad has two stars. Did we make a mistake?” Two stars is a comparison score. It tells you where the facility’s health inspection results fell among Illinois nursing homes that month, moved up or down by its staffing and quality-measure stars, which are scored against national cut points. Whether your father is getting good care shows in his chart, in the facility’s inspection reports and in what you see when you visit at different hours. The rest of this article explains what the stars measure and how to read them.

The Centers for Medicare and Medicaid Services (CMS) publishes the ratings on Care Compare for every nursing home that takes Medicare or Medicaid. CMS describes the system’s goal as giving residents and their families an easy way to understand nursing home quality and to tell higher-performing homes from lower-performing ones. The health inspection stars compare a facility with the other facilities in its state; the staffing and quality-measure stars are scored against national cut points that CMS publishes. The sections below explain what is being compared.

What Is the CMS Five-Star Rating System?

CMS evaluates nursing homes participating in Medicare and Medicaid using three primary categories:

Health inspections
Staffing levels
Quality measures

Each facility receives a star rating (from one to five stars) in each category, as well as an overall rating.

The health inspection stars are graded on a curve within each state. Under the July 2026 CMS Technical Users’ Guide, the 10 percent of a state’s facilities with the lowest health inspection scores, meaning the fewest deficiency points, receive five stars, the bottom 20 percent receive one star, and the middle 70 percent are split evenly among two, three and four stars. CMS resets those cut points every month so the spread within each state stays about the same over time. The overall rating starts from the health inspection stars. It moves up one star for five-star staffing and down one for one-star staffing, then does the same for the quality measures. A facility whose inspections earned one star can move up only one star on the strength of the other two.

Health Inspections

This category is based on results from state inspections, complaint investigations, and surveys. Inspectors evaluate whether facilities comply with federal regulations governing:

Infection control
Pressure ulcer prevention
Fall prevention
Medication management
Resident rights
Abuse and neglect protections

Each deficiency adds points to the facility’s health inspection score according to how serious and how widespread it was, and a higher score means a lower rating.

Staffing

CMS scores staffing from six measures:

Total nursing hours per resident per day (registered nurses, licensed practical nurses and nurse aides), adjusted for how much care the residents need
Registered nurse hours per resident per day, adjusted the same way
Total nursing hours per resident per day on weekends
The share of nursing staff, and separately of registered nurses, who left over the past twelve months
The number of administrators who left over the past twelve months

The hours come from payroll records the facility submits to CMS each quarter and are averaged across the quarter, with the weekend measure counting Saturdays and Sundays only; staffing on a given night is a question to ask on your visit. The firm’s article on nursing home understaffing in Illinois explains how staffing records are used when a resident is hurt.

Quality Measures

The quality measures come from two sources: the assessments a facility files on each resident and Medicare claims. The July 2026 guide scores fifteen of them, including:

Pressure ulcers and pressure injuries
Falls with major injury
Hospital stays and emergency room visits, counted from Medicare claims
Antipsychotic medication use
Loss of the ability to walk or to handle daily activities, urinary tract infections and catheter use

Together, these metrics are intended to give families a snapshot of overall performance.

What lowers a nursing home’s star rating?

A facility’s stars move with its own record. Under the CMS scoring rules, these are the things that pull a rating down:

Deficiencies cited on the two most recent annual inspections and on complaint and infection control inspections over the past three years, weighted by how serious and how widespread each one was, with the most recent annual inspection counting most.
Repeat revisits, meaning inspectors had to return more than once before a cited problem was fixed.
Low nursing hours per resident per day in the payroll data, and high turnover among nurses and administrators.
Low scores on the quality measures, such as pressure ulcers, falls with major injury, hospital stays and antipsychotic medication use.

Because the inspection stars are set on a curve within each state, about one Illinois home in ten holds five health inspection stars in any month and about two in ten hold one, and that share stays about the same from month to month. A small number of homes at the top of the inspection scale in any state is a feature of the scale; the overall star then moves up or down with the facility’s own staffing and quality-measure scores. The verdict on one facility comes from reading its own inspection reports.

What can a star rating tell you, and what does it leave out?

The CMS rating system is a helpful starting point, but it is not the full story.

Important limitations include:

Ratings are based on periodic inspections, not continuous monitoring.
Quality measures rely partly on facility-reported data.
Recent changes may not immediately reflect in ratings.
A facility with a mid-level rating may still have serious individual incidents.

Families should view ratings as one tool among many, not a guarantee of safety.

What can families do before choosing a facility, and after?

When evaluating a nursing home, consider:

Reviewing the facility’s most recent inspection reports.
Asking about staffing ratios on different shifts.
Visiting at varied times of day.
Observing cleanliness and resident engagement.
Speaking with current residents and families.

If your family member already lives in a facility and you notice unexplained injuries, worsening pressure sores, dehydration, frequent falls or sudden behavioral changes, ask the charge nurse or the administrator that day to have your family member seen by a nurse or physician, and call 911 for an emergency. Write down the date, the names and what you saw while it is fresh. The next sections explain what a citation is worth and how to report what you saw.

What does a low rating or an inspection citation mean if your parent was hurt?

Federal rules at 42 CFR Part 483 set the standards a facility must meet to take Medicare or Medicaid, and state inspectors cite the facility when it falls short. Those citations are public records. A low rating or an inspection citation is a reason to ask questions and a piece of evidence a lawyer will use, and a rating by itself changes nothing about a facility’s legal responsibility.

Proof that your family member was neglected comes from a different place: the resident’s chart, the care plan and the facility’s records for the days in question. Your family has to show what the facility failed to do and that the failure caused the injury, and for a pressure injury that usually takes a nurse or physician who reviews the chart.

If you suspect a facility has failed a resident in your family, get your family member seen first, then report what you saw to the Illinois Department of Public Health, which takes nursing home complaints at 800-252-4343 and through its online complaint form. The firm’s guide to reporting nursing home neglect in Illinois walks through the process. Robert Parker reviews nursing home injury cases for families in Peoria and central Illinois, starting with whatever records and notes you have.

Frequently Asked Questions

Does a low star rating mean an Illinois nursing home is neglecting my parent?

A low rating or an inspection citation is a reason to ask questions and a piece of evidence a lawyer will use. Proof that a resident was neglected comes from the resident’s chart, the care plan and the facility’s records, and a rating by itself changes nothing about a facility’s legal responsibility.

How are the health inspection stars assigned to Illinois nursing homes?

The health inspection stars are graded on a curve within each state. Under the July 2026 CMS guide, about one facility in ten holds five stars and about one in five holds one star at any given time, and CMS resets the cut points each month so that spread stays about the same. The overall star then moves up or down with the facility’s own staffing and quality-measure scores.

How do I report suspected neglect at an Illinois nursing home?

Ask that your family member be seen by a nurse or physician, call 911 for an emergency, and then report what you saw to the Illinois Department of Public Health at 800-252-4343 or through its online complaint form. The firm’s guide to reporting nursing home neglect in Illinois explains what happens after a complaint is filed.

If a low rating or an inspection report has you worried about a parent who already lives in a facility, call 309-673-0069 and describe what you have seen. Nursing home cases are part of Robert Parker’s Peoria personal injury practice.

Need a lawyer? This article is part of our Peoria Nursing Home Injury Lawyer practice area. Call Parker & Parker at 309-673-0069 for a free consultation.