Turnover and your star rating: how the staffing measure works
How CMS turns your staffing hours and turnover into a star rating, how much turnover is worth along the way, and what the rating changes.
Three ratings, one overall rating
Care Compare gives each nursing home an overall rating of one to five stars, built from three ratings of its own: health inspections, staffing and quality measures.
The overall rating starts with the health inspection rating. A five-star staffing rating adds a star, and a one-star staffing rating takes one away. The quality measure rating then does the same. If the health inspection rating is one star, the other two together can lift the overall rating by one star at most.
So staffing moves your overall rating only at the ends, at five stars or one.
Six measures, 380 points
The staffing rating adds up points from six measures. Three are staffing levels: nursing hours per resident per day, adjusted for how much care residents need. Three are turnover.
| Measure | Up to |
|---|---|
| Total nurse staffing hours per resident per day | 100 points |
| RN staffing hours per resident per day | 100 points |
| Total nurse staffing hours per resident per day on weekends | 50 points |
| Total nurse turnover | 50 points |
| RN turnover | 50 points |
| Administrator turnover | 30 points |
| All six | 380 points |
Turnover is worth up to 130 of the 380 points. Staffing hours are worth the other 250.
The points add up to stars like this:
| Staffing rating | Total points |
|---|---|
| 1 star | Under 155 |
| 2 stars | 155 to 204 |
| 3 stars | 205 to 254 |
| 4 stars | 255 to 319 |
| 5 stars | 320 to 380 |
How turnover earns points
For total nurse turnover and RN turnover, CMS splits nursing homes into ten groups. The lower your turnover, the more points: 50 for the lowest group, then 5 fewer for each group after, down to 5 for the highest.
Administrator turnover is a count instead. No administrator departures in the year earns 30 points, one earns 25, and two or more earn 10.
These are the cut points for the two nurse measures today. CMS last changed them in July 2024.
| Points | Total nurse turnover | RN turnover |
|---|---|---|
| 50 | 31.126% or lower | 20.000% or lower |
| 45 | 31.127% to 37.500% | 20.001% to 28.571% |
| 40 | 37.501% to 41.739% | 28.572% to 35.714% |
| 35 | 41.740% to 45.679% | 35.715% to 41.667% |
| 30 | 45.680% to 49.254% | 41.668% to 44.444% |
| 25 | 49.255% to 53.425% | 44.445% to 52.941% |
| 20 | 53.426% to 57.692% | 52.942% to 60.000% |
| 15 | 57.693% to 62.791% | 60.001% to 66.667% |
| 10 | 62.792% to 69.792% | 66.668% to 80.000% |
| 5 | 69.793% or higher | 80.001% or higher |
For example, at 47% total nurse turnover, the average for buildings of about 100 beds, a building earns 30 of the 50 points. At 41%, it would earn 40. Ten points can decide a star when a building sits near a cut point.
What counts as turnover here
The turnover measures come from the same payroll data as the staffing hours. Someone counts as having left once they go 90 days in a row without working a shift, and only people who work at least 120 hours in their first 90 days count at all. One year of turnover takes six quarters of data to calculate.
So the rate behind your points leaves out many of the new hires who leave fastest. We explain who it misses in How CMS counts turnover, and who it leaves out.
When data are missing
Missing data costs the most. If a building misses even one quarter of staffing data in the turnover calculation, or submits data with errors, it gets the fewest points possible: 5 each for total nurse and RN turnover, and 10 for administrator turnover.
Some problems cost the whole staffing rating. A building gets one star for staffing that quarter if it doesn’t submit staffing data by the deadline, or if its data show four or more days with residents in the building but no RN hours. If a CMS audit finds significant differences between the hours reported and the hours verified, or a building doesn’t respond to one, its staffing rating is one star for three months.
One quieter problem: when employee IDs change, for example in a switch of payroll systems, it can look as if every nurse left on the same day. CMS leaves out the nurse turnover measures for a building with a day of 100% turnover, and a measure left out this way gets the fewest points.
Buildings with fewer than five eligible nursing staff don’t get the nurse turnover measures at all. Their points are rescaled from the measures they do have.
A newer reason the rating matters
In September 2026, CMS began using a shorter standard survey nationwide for nursing homes that meet its bar for high performance, and said it would mark those buildings with an icon on Care Compare starting October 8, 2026.
To qualify, a building needs a five-star overall rating and at least three stars for staffing, among other criteria. CMS says that beyond the five-star requirement, a low staffing rating is the most common reason buildings miss out. It expects about 12% of nursing homes to qualify.
What you can do
- Find your three turnover numbers on Care Compare, and see how close each sits to the next cut point.
- Send complete staffing data on time, every quarter. A missing quarter earns the same points as the highest turnover.
- Keep employee IDs the same when payroll or HR systems change.
- Support new hires through their first months. The ones CMS doesn’t count still cost you, and the ones it does count move your points.
- Talk with the people who stay. Stay conversations are a simple place to start.
Sources
- Centers for Medicare & Medicaid Services (CMS). Design for Care Compare Nursing Home Five-Star Quality Rating System: Technical Users’ Guide, September 2026. The overall rating, the six staffing measures, their points, the star cut points (Table 3), the nurse turnover cut points (Appendix Table A2) and the rules for missing data.
- CMS. QSO-26-14-NH REVISED: Nursing Home Risk-Based Survey National Implementation. Memo, September 29, 2026.
- CMS. Provider Information, Nursing Home Care Compare data, file processed February 1, 2026. The 47% average for buildings of about 100 beds is our calculation from this file.
- Medicare.gov. Care Compare.