How nursing home and aged care ratings work (US & Australia)
Every nursing home in the United States and every residential aged care home in Australia is given an overall rating from 1 to 5 stars by its national regulator. In the US it is the Centers for Medicare & Medicaid Services (CMS) Five-Star Quality Rating, published on Medicare.gov Care Compare. In Australia it is the Star Ratings system published by the Department of Health, Disability and Ageing. Both are the single best public indicators of a home's quality, but they measure slightly different things — this guide explains both.
United States — CMS Five-Star Quality Rating
CMS combines three component ratings into an overall 1-to-5 star score for every Medicare- and Medicaid-certified nursing home: Health Inspections (results of the last three on-site standard surveys and any complaint investigations), Staffing (registered nurse and total nurse staffing hours per resident per day, payroll-verified through PBJ data and case-mix adjusted), and Quality Measures (15 clinical indicators drawn from MDS assessments and Medicare claims, covering both long-stay and short-stay residents).
US — Health Inspections
State surveyors inspect every nursing home roughly once every 9–15 months. Deficiencies are scored by scope and severity. Homes in the top 10% of their state get 5 stars, the bottom 20% get 1 star, and the rest are distributed across 2–4. This is the most heavily weighted component.
US — Staffing
CMS uses payroll-based journal (PBJ) data to verify actual hours worked, then case-mix adjusts for resident acuity. Homes are rated separately on RN staffing and total nurse staffing; the lower of the two drives the staffing star. Missing or unreliable PBJ data automatically drops staffing to 1 star.
US — Quality Measures
Fifteen clinical indicators are tracked, including pressure ulcers, falls with major injury, antipsychotic use, urinary tract infections, ability to move independently, and rehospitalisation rates. Lower rates of harm and better functional outcomes translate into higher scores.
Australia — Star Ratings
Australia's overall Star Rating is calculated from four equally weighted scores: Compliance (regulatory action and accreditation history with the Aged Care Quality and Safety Commission), Residents' Experience (independent survey responses), Staffing (care minutes delivered per resident per day), and Quality Measures (clinical indicators such as pressure injuries, falls and unplanned weight loss).
AU — Compliance
Compliance reflects how well a home meets the Aged Care Quality Standards. A rating drops when the Aged Care Quality and Safety Commission issues a notice of non-compliance or sanction. Homes with no recent compliance action typically score 4 or 5.
AU — Residents' Experience
Independent interviewers survey a sample of residents about respect, food, staff responsiveness and feeling safe. Higher scores mean residents themselves report a better day-to-day experience.
AU — Staffing
Since October 2023, every Australian home must deliver an average of at least 200 care minutes per resident per day, including 40 minutes of registered nurse time. Homes that exceed the target score higher; homes that miss it score lower. A registered nurse must also be on site 24/7.
AU — Quality Measures
Five clinical indicators are tracked in Australia: pressure injuries, physical restraint use, unplanned weight loss, falls and major injury, and medication management. Lower rates of harm translate into higher scores.
How to use the rating (both countries)
Treat 4- and 5-star homes as safe shortlists, look closely at any 3-star home (the national average), and ask hard questions before considering a 1- or 2-star home. Open every sub-category — a 4-star home with a 1-star Staffing score may struggle on busy shifts. Always cross-check the rating against an in-person visit.
Frequently asked questions
Authoritative sources
The figures and rules in this guide are drawn from the following official and independent sources. Open any link to verify the latest published numbers.
- Five-Star Quality Rating System — Technical Users' Guide
CMS.gov
- Care Compare: Nursing Homes
Medicare.gov
- Star Ratings — residential aged care
Australian Department of Health, Disability and Ageing
- GEN Aged Care Data — Star Ratings dataset
AIHW / GEN Aged Care
- Payroll-Based Journal (PBJ) staffing data
CMS.gov
About this guide
Written and reviewed by the Nursing Home Match editorial team. We update guides at least annually and verify every figure against the official sources listed above. This guide is general information, not personal, medical, financial or legal advice. Always confirm details on Medicare.gov Care Compare (United States) or My Aged Care (Australia), or speak to a qualified adviser before making decisions.