When families in Wisconsin begin searching for a safe and trustworthy nursing home, one of the first tools they encounter is the Centers for Medicare & Medicaid Services (CMS) Five-Star Quality Rating System. This rating system, displayed on Medicare's Care Compare website, is designed to give families a quick snapshot of a facility's quality. 

But what does the Five-Star Rating really mean? And how should families throughout Wisconsin use it when choosing a nursing home for a loved one?

This rating is just one tool families can use. Below is a guide to help you use the information effectively. 

What is the CMS Five-Star Rating System?

The CMS Five-Star Rating System is a federal quality measure used to evaluate nursing homes across the country, including every facility in Wisconsin that participates in Medicare or Medicaid. 

CMS bases each nursing home's overall rating on three major areas:

1. Health Inspections

This is the most heavily weighted category. It evaluates results from:

• State survey inspections
• Complaint investigations
• Revisits after citations
• Severity and frequency of past violations

This category is especially important because it directly reflects resident safety and regulatory compliance.

2. Staffing Levels

This rating examines:

• RN staffing hours
• LPN and CNA hours
• Staff-to-resident ratios
• Adjusted staffing based on resident acuity

Chronic understaffing is one of the leading causes of falls, pressure wounds, infections, medication errors, and neglect in Wisconsin nursing homes. 

3. Quality Measures (QMs)

Quality measures reflect resident outcomes, such as:

• Rates of falls
• Decline in mobility
• Unexplained weight loss
• Pressure wound development
• Hospitalizations
• Use of antipsychotic medications

The higher the quality, the better the rating should be...at least in theory.

CMS combines all three to assign an overall rating between 1 and 5 stars, with:

• 1 star = Much below average
• 5 stars = Much above average

Why Does the CMS Five-Star Rating Matter for Wisconsin Families?

The CMS rating system gives families a starting point when comparing long-term care facilities in Milwaukee, Green Bay, Racine, and throughout Wisconsin.

But its true value comes from understanding what the ratings actually signal. 

A. A Low Rating Is a Significant Red Flag

Wisconsin nursing homes with 1 or 2 star ratings have a history of:

• Repeated care violations
• Unsafe staffing levels
• Record of preventable injuries
• Infections, pressure wounds, and falls
• Persistent noncompliance with federal standards

If a facility in Wisconsin has a low rating, it is not by accident. It reflects ongoing performance issues. 

B. A High Rating Does Not Always Guarantee Safety

While 4 and 5 star facilities might perform better, the rating also:

• May be influenced by self-reported data
• Does not always capture staffing shortages accurately
• May not reflect recent leadership changes
• Can lag behind current conditions

Some 5-star facilities have been cited for serious neglect. A rating should be one tool, not the only measure. 

The health inspection score is the most reliable category because it relies on in-person state inspections. Still, inspectors can only address what they know. If neglect is not reported, serious issues may never appear in a facility's rating. That's why reporting concerns, by staff, residents, or families, is essential. 

How Should Families Use the CMS Five-Star Ratings When Searching for a Wisconsin Nursing Home?

The Five-Star Rating is a great starting point. But, it should be combined with other resources. When searching for a Wisconsin nursing home:

✔ Look at the overall rating, but dig deeper. Compare the separate ratings for health inspections, staffing, and quality measures. 

✔ Compare the CMS ratings with Wisconsin DHS inspection reports. State survey histories often reveal patterns of violations that star ratings don't fully capture. Neglect must be reported in order for it to appear in inspection reports. 

✔ Look at trends over time. Is the facility improving, declining or showing the same issues year after year? Is the facility constantly switching ownership? Is the facility always hiring new staff?

✔ Cross-check the CMS rating with the Special Focus Facility list. The SFF list is another tool to determine the trend of the facility. For example, a 3-star nursing home that was recently on the SFF list may still have systemic issues. 

✔ Visit the facility in person. No rating can substitute for what you observe when you walk through the door. If you can, try to visit the facility unannounced. 

✔ Trust your instincts. If the facility feels chaotic, understaffed, or dismissive of your concerns, it probably is.

Do You Need a Wisconsin Nursing Home Injury Lawyer?

While the CMS Five-Star Rating System helps families identify:

• Which facilities struggle with chronic deficiencies
• Which facilities have strong/weak staffing ratios
• Whether a nursing home is improving or declining
• How a facility compares to others in the state

the rating alone cannot guarantee your loved one's safety. Even highly rated Wisconsin nursing homes can have serious lapses in care, incidents of neglect, or corporate decisions that create dangerous conditions behind the scenes.

That's where an experienced Wisconsin nursing home attorney becomes essential. If your loved one was harmed, whether the facility had a 1-star or 5-star rating, you may need help uncovering what truly happened, gathering records, and holding the facility accountable. 

Lojewski Abuse & Injury Law represents families across Wisconsin in cases involving:

• Nursing home neglect
• Assisted living and memory care injuries
• Falls and fractures
• Pressure wounds (bedsores)
• Medication errors
• Choking and aspiration events
• Elopement incidents 
• Infections or sepsis
• Physical or sexual abuse
• Sudden, unexplained declines
• Wrongful death in long-term care

These cases often involve digging deeper than public ratings, such as reviewing staffing logs, corporate ownership, medical records, DHS surveys, and internal documentation to determine whether the facility violated state or federal care standards. 

If you have concerns about a Wisconsin nursing home's quality of care, or if your loved one was injured or passed away due to a nursing home's negligence, contact Lojewski Abuse & Injury Law. Attorney Kristen Lojewski is committed to standing with Wisconsin families when it matters most.  

Pursuing the Truth. Protecting the Vulnerable.