Full Definition

The Five-Star Quality Rating System is a public reporting tool created by the Centers for Medicare & Medicaid Services (CMS) to help consumers compare nursing home quality. Every Medicare- and Medicaid-certified nursing home in Texas receives an overall rating of 1–5 stars, as well as individual ratings in three domains.

The three rating domains are: Health Inspections (based on results of the last three years of state inspections, weighted toward the most recent), Staffing (based on nurse aide hours per resident day, RN hours per resident day, and total nurse staffing hours), and Quality Measures (based on clinical outcomes data reported through the Minimum Data Set, including rates of falls, pressure ulcers, hospitalization, and functional decline).

The overall Five-Star rating combines these three domains, with health inspections weighted most heavily. A facility can have a high staffing star rating but a low inspection star rating — so it is important to review each component separately.

While Five-Star ratings are a useful starting point, they have limitations. Staffing data is self-reported (though increasingly verified against payroll records). Inspection frequency and thoroughness vary by state and surveyor team. Five-star ratings should be combined with in-person visits, review of recent inspection reports, and conversations with staff and residents’ families.