More than one third of the nation’s 15,500 nursing homes, accounting for 39 percent of all nursing home residents, received relatively low ratings of 1 or 2 stars under the federal government’s recently revamped Five-star Quality Rating System, according to a new analysis by the Kaiser Family Foundation.

The rating system, overseen by the Centers for Medicare and Medicaid Services, assigns ratings of 1 to 5 stars to all Medicare- and Medicaid-certified nursing homes based on deficiencies that may be reported during health inspections, and measures relating to staffing and quality. The ratings, part of CMS’s Nursing Home Compare tool, aim to give consumers better information to compare and choose among nursing homes in their area, which is especially important given concerns about reported problems arising from inadequate staffing, fire safety hazards and substandard care — serious issues in light of the vulnerability of the nursing home population.

The Kaiser study, based on an analysis of star ratings in the Nursing Home Compare database, finds higher overall ratings among non-profit homes, with one-third of non-profit homes earning 5 stars compared to 18 percent of for-profit homes. It also finds generally higher ratings for smaller nursing homes (with fewer beds) than larger ones. Thirty-nine percent of homes with fewer than 60 beds got a 5-star rating compared 14 percent of homes with more than 120 beds.

The report documents considerable variation in nursing home ratings across the states.  In 22 states and the District of Columbia, for example, at least half of nursing homes received relatively high ratings of 4 or 5 stars.  Conversely, in 11 states more than 40 percent of nursing homes got relatively low ratings of 1 or 2 stars.  The states with the greatest share of low-rated nursing homes include Texas, where  51 percent of all nursing homes received a 1 or 2 star rating, followed by Louisiana (49%) and Georgia, Oklahoma and West Virginia (46% each).   In 9 states, at least one in five nursing homes received only 1 star, the lowest possible rating.

At the county level, two-thirds of all counties in the U.S. have at least one nursing home with a 4- or 5- star rating, while the remaining one-third of counties have only nursing homes rated with fewer stars (27%) or no Medicare or Medicaid-certified nursing homes at all (7%). The presence of a highly-rated home in a county doesn’t necessarily imply that area patients will live in one, since bed availability is a factor and people may place a high priority on being close to family.

For the full analysis, Reading the Stars: Nursing Home Quality Star Ratings, Nationally and by State, as well as more resources on Medicare, visit kff.org.

Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.