The Numbers Nursing Homes Report on Themselves

Are nursing home quality measures self-reported?

For the most part, yes — and knowing which parts changes how much the numbers should weigh on your decision. A nursing home's quality-measure scores are calculated mainly from the Minimum Data Set, a standardized assessment the facility's own staff complete for each resident and submit to the government 1Ref 1Centers for Medicare & Medicaid Services (2025).Design for Care Compare Nursing Home Five-Star Quality Rating System: Technical Users' Guide.That the quality-measure ratings are calculated under the CMS methodology from facility-submitted resident-assessment (MDS) data plus some Medicare claims data, and how the three domains are scored and combined.. Because the same home both delivers the care and records how it went, these measures are self-reported. The other two ratings behind its star are not.

The Minimum Data Set (MDS) is the federally required resident assessment a facility fills out and submits; most quality measures are built from it.

The Five-Star Quality Rating System folds three separate domains — health inspections, staffing, and quality measures — into one overall number 2Ref 2Centers for Medicare & Medicaid Services (2026).Five-Star Quality Rating System.That the Five-Star system rates each certified nursing home overall and on three domains — health inspections, staffing, and quality measures.. Only the quality-measure domain rests this heavily on what the facility reports about itself, which is why self-reported quality measures are worth understanding before you trust a five-star badge.

Where the quality-measure numbers come from

Quality measures fall into two groups by source. Most are calculated from the MDS assessments the facility submits — things like the share of residents who fell, developed a pressure sore, lost the ability to move independently, or received an antipsychotic. A smaller set is drawn from Medicare billing claims, such as how many residents were hospitalized or returned home successfully. The MDS-based group is self-reported; the claims-based group is not 1Ref 1Centers for Medicare & Medicaid Services (2025).Design for Care Compare Nursing Home Five-Star Quality Rating System: Technical Users' Guide.That the quality-measure ratings are calculated under the CMS methodology from facility-submitted resident-assessment (MDS) data plus some Medicare claims data, and how the three domains are scored and combined..

That split matters because the two groups can be trusted differently. A number the facility assembles from its own charting depends on how the facility charts. A number pulled from hospital and Medicare claims is generated somewhere else, and it is far harder for a home to shade in its own favor.

The three ratings behind the star, and who reports each

A star rating is not one measurement but three, and they differ sharply in who produces the data. Reading the star well means reading the domains underneath it, because a strong quality-measure score can prop up an overall star that a weak inspection record should have pulled down. The table shows where each domain's data comes from.

The health inspection domain is the one an outside surveyor produces, drawn from inspections over the last three years 3Ref 3Centers for Medicare & Medicaid Services (2026).Survey Summary (Nursing homes including rehab services dataset).That the health-inspection results come from state surveyors' on-site inspections over the last three years, independent of the facility.. The staffing figures now come from the Payroll-Based Journal — payroll records rather than a one-time estimate — and the dataset behind the ratings publishes both the staffing hours per resident day and the quality-measure scores for every home 4Ref 4Centers for Medicare & Medicaid Services (2026).Provider Information (Nursing homes including rehab services dataset).That the downloadable dataset behind Care Compare publishes each facility's staffing measures and quality-measure scores..

Why self-reported measures can mislead

The weakness of a self-reported measure is not usually outright fraud — it is that what gets counted depends on how a facility assesses and codes. If two homes define or document a fall, a pressure sore, or a resident's decline differently, their quality-measure scores can diverge even when the care is similar. It is a leading source of misleading star ratings, and a reason a very high quality-measure score sitting beside a poor inspection record should raise a question rather than settle one.

A quality-measure score describes what a home recorded about its own residents — not what an inspector saw.

None of this means the measures are useless. It means they carry an asterisk. Treated as one input among several — read next to the independent inspection findings — they add real information. Treated as the whole story, they can flatter a home that charts optimistically.

The measures that are harder to game

If you want the sturdier numbers, look toward the claims-based measures. Because they come from hospital and Medicare billing rather than the facility's own assessments, measures like the rate of residents sent to the hospital, emergency-department visits, and the share who returned to the community are much harder for a home to influence on paper 1Ref 1Centers for Medicare & Medicaid Services (2025).Design for Care Compare Nursing Home Five-Star Quality Rating System: Technical Users' Guide.That the quality-measure ratings are calculated under the CMS methodology from facility-submitted resident-assessment (MDS) data plus some Medicare claims data, and how the three domains are scored and combined.. They are not perfect, but they reflect events recorded outside the building.

Paired with the health inspection rating — the domain an independent surveyor produces — the claims-based measures give you a view of a home that does not depend on trusting its own charting. When the self-reported quality measures glow but the claims-based measures and the inspection history do not, believe the second pair.

How to read quality measures without being fooled

Read the quality measures last, not first. Start with the health inspection history and the staffing data, which are produced or audited outside the facility, then use the quality measures to fill in the picture rather than to lead it. Compare homes on the same measure rather than on overall stars, and weigh a suspiciously perfect quality score against everything else you can see.

• Anchor on the independent data. Let the inspection findings and payroll-based staffing set your baseline.
• Prefer claims-based measures over MDS-based ones where you can tell them apart.
• Visit. No dataset shows you a hallway at dinnertime.

All of these figures live in one place: the federal dataset behind CMS Care Compare publishes each home's staffing and quality-measure scores 4Ref 4Centers for Medicare & Medicaid Services (2026).Provider Information (Nursing homes including rehab services dataset).That the downloadable dataset behind Care Compare publishes each facility's staffing measures and quality-measure scores., and Care Compare is where you can line them up side by side 5Ref 5Centers for Medicare & Medicaid Services (2026).Find Healthcare Providers: Compare Care Near You (Care Compare).That Care Compare is the official federal tool where these ratings and measures are displayed for side-by-side comparison.. If the numbers and what you see on a tour do not match, your state's Long-Term Care Ombudsman can help you make sense of the gap, at no cost, in every state 6Ref 6Administration for Community Living (HHS) (2025).Long-Term Care Ombudsman Program.That every state has a Long-Term Care Ombudsman program that advocates for residents and helps resolve complaints about their care..