Last Updated: June 11, 2026

Only about 15% of U.S. nursing homes receive high quality ratings. Most facilities have violations or operational issues. This poor national performance suggests you must carefully evaluate any facility; obtain current IDPH inspection reports and speak with residents’ families to assess actual quality.

Only a Small Percentage of U.S. Nursing Homes Receive Top Quality Ratings

Choosing a nursing home is one of the most important decisions a family can make. Many families turn to the federal government’s rating system for guidance, but the results may surprise you.

According to data published by the Centers for Medicare & Medicaid Services (CMS), only a small percentage of nursing homes nationwide receive the highest overall quality rating.

The CMS Five-Star Quality Rating System was designed to help families compare nursing homes based on objective data. But the ratings also reveal a sobering reality: quality varies significantly from facility to facility.

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.

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

Deficiencies in these areas can significantly lower a facility’s rating.

Staffing

Staffing levels are critical to resident safety. CMS evaluates:

The number of registered nurses (RNs)
Total nursing hours per resident per day
Staffing consistency

Chronic understaffing is frequently linked to preventable harm, including untreated bedsores, falls, dehydration, and delayed medical intervention.

Quality Measures

Quality measures include clinical data reported by facilities, such as:

Rates of pressure ulcers
Falls with major injury
Hospital readmissions
Antipsychotic medication use
Weight loss

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

Why So Few Facilities Receive Top Ratings

Several factors contribute to lower ratings nationwide:

Repeated inspection deficiencies
Infection control violations
Inadequate staffing levels
High rates of preventable complications
Failure to meet federal standards

While many facilities provide appropriate care, systemic challenges, including staffing shortages and resource limitations, continue to affect quality across the industry.

What the Ratings Do (and Don’t) Tell You

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.

Steps Families Can Take

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 a loved one is already in a facility and you notice warning signs such as unexplained injuries, worsening pressure sores, dehydration, frequent falls, or sudden behavioral changes, act promptly.

Accountability Matters

Federal regulations exist to protect nursing home residents. Facilities that participate in Medicare and Medicaid are legally required to meet those standards.

When nursing homes fail to provide adequate care, residents can suffer serious, and sometimes preventable, harm.

The fact that relatively few facilities achieve top ratings underscores the importance of vigilance, transparency, and accountability in long-term care.

At Parker & Parker Attorneys, we represent families whose loved ones have suffered neglect or abuse in nursing homes. If you suspect that a facility has failed to meet required standards of care, we can help you evaluate your options.

Because quality ratings should never be the only safeguard protecting vulnerable residents.

No family should have to face the aftermath of a wrongful death alone. Our our personal injury practice are here to help during this difficult time.

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.

Only 15 percent of US nursing homes receive good rating