Michigan Nursing Home Ratings by County: What the Federal Data Show (September 2026)

Short answer: as of the federal government's August 2026 nursing home file, Michigan has 422 Medicare- and Medicaid-certified nursing homes, and 62 of them, one in seven, carry the abuse icon that the Centers for Medicare & Medicaid Services (CMS) attaches to homes cited for abuse or neglect. The national rate is about one in ten. Seventy-eight Michigan homes hold the lowest possible overall rating of one star. Oakland County has more one-star homes than any other county in the state and accounts for 28 percent of all CMS fines paid by Michigan homes, with 10 percent of the homes. For-profit homes, which are three out of four homes in the state, average 2.9 stars against 3.8 for nonprofit and government homes and report a full hour less nursing care per resident per day. The county tables, the chain comparison and the list of homes CMS is watching most closely are below, along with what to do if someone you love is in one of them.

What the federal ratings measure

CMS rates every certified nursing home from one to five stars on three things: the results of state health inspections, staffing levels, and clinical quality measures such as falls, pressure ulcers and hospital readmissions. The overall rating combines the three. Inspections are carried out in Michigan by the Department of Licensing and Regulatory Affairs (LARA) under federal rules, and the findings are what drive most of the rating.

Two flags matter more than the stars. The abuse icon appears on a home that was cited on inspection for abuse that caused harm to a resident within the past year, or for abuse that could have caused harm in each of the last two years; the federal abuse tag covers neglect as well. A Special Focus Facility (SFF) is a home with a history of serious problems that CMS inspects twice as often; "SFF candidates" are the homes next in line for that program. None of this is a lawsuit or a finding by a court. It is the federal government's own scorecard, published monthly at Medicare Care Compare, and it is the first thing a family should read before signing an admission agreement.

Michigan statewide: the numbers

The August 2026 file lists 422 Michigan homes with 44,005 certified beds and about 36,300 residents on an average day. The overall ratings break down as 78 one-star homes (18.5 percent), 78 two-star, 86 three-star, 73 four-star and 105 five-star, with two homes not yet rated. Nationally, 20.5 percent of homes are one-star, so Michigan's share of bottom-rated homes is slightly better than the country's.

The abuse figure is not. Sixty-two Michigan homes carry the abuse icon, 14.7 percent of the state's homes, against 9.7 percent of the 14,690 homes nationwide. Twelve Michigan homes are in the Special Focus program or on its candidate list.

Money follows the citations. Over the roughly three-year window CMS tracks, 165 Michigan homes paid fines totaling $12,956,259, a median of $50,895 per fined home, and 119 homes were hit with a denial of Medicare or Medicaid payment for new admissions, the sanction that usually gets an operator's attention. Staffing, which the research ties most directly to neglect, averages 3.99 total nurse hours per resident per day in Michigan against 3.86 nationally, but the average hides the tails: 23 homes carry a one-star staffing rating, and 76 homes report less than 15 minutes of registered nurse time per resident per day on weekends. Forty of the 393 homes that report turnover lose more than 60 percent of their nursing staff in a year.

County by county

Counties with at least six certified homes, sorted from lowest to highest average overall rating. Fines are the CMS totals for the three-year window, in dollars.

Three things stand out for Metro Detroit families. Wayne County, with the most homes in the state, sits in the middle of the pack: 63 homes, 12 of them five-star, 8 one-star, 9 with the abuse icon. Macomb County is the strongest of the three big counties on every measure. Oakland County is the outlier, and not in the direction its property values suggest.

Where the problems cluster: Oakland County, for-profit ownership, and a handful of chains

Oakland County's 43 homes average 2.45 stars. Fourteen are one-star, a third of the county's homes against 18.5 percent statewide. Nine carry the abuse icon. Three are in or headed for the Special Focus program. And Oakland homes paid $3.68 million of the state's $12.96 million in CMS fines, 28 percent of the total, including four of the five largest penalties in Michigan: The Villa at Green Lake Estates in Orchard Lake ($434,664 in fines over four actions), Optalis Health and Rehabilitation of Troy ($388,982 over five), Greenfield Rehab and Nursing Center in Royal Oak ($367,987 over four) and Medilodge of Farmington ($279,675 over five).

Ownership explains a good deal of the statewide pattern. Michigan's 323 for-profit homes average 2.89 stars; its 99 nonprofit and government homes average 3.85. Twenty-one percent of for-profit homes are one-star against 10 percent of the others. For-profit homes report 3.75 nurse hours per resident per day against 4.80, and 46 percent annual nursing turnover against 38 percent. Fifteen percent of for-profit homes carry the abuse icon, against 12 percent of nonprofit and government homes.

The largest chains, as CMS groups them, diverge sharply. Chains with at least nine Michigan homes:

Trilogy's 14 Michigan homes average 4.64 stars with no one-star homes, no abuse icons and $66,414 in fines. The Orchards Michigan's 15 homes average 1.87 stars, and nine of them are one-star. Optalis has an abuse icon on a third of its 27 homes. A chain's name on the sign tells a family more than the brochure does.

The homes CMS is watching most closely

Two Michigan homes are currently Special Focus Facilities and ten are candidates, per the August 2026 file:

Homes in the Special Focus program are not rated while they are in it, which is why the two SFFs show no stars.

Homes with both a one-star overall rating and the abuse icon

Twenty-six Michigan homes hold the lowest overall rating and carry the abuse icon at the same time. Ten of the 26 are in Metro Detroit.

A low rating does not mean every resident in a home is being mistreated, and a five-star rating does not guarantee safety; ratings lag the inspections behind them by months. But a home that is one-star and flagged for abuse at the same time has, by the government's own account, failed the people in it more than once.

If a parent is in one of these homes

Look first, then act. Pull the home's page on Care Compare and read the actual inspection reports, not just the stars; the reports describe what surveyors saw. Visit at different times, including weekends and evenings, when staffing is thinnest. Watch for the signs that show up in nearly every neglect case we see: unexplained bruises or fractures, bedsores, rapid weight loss, dehydration, soiled bedding, medication mistakes, a resident who is suddenly withdrawn or fearful, and falls that nobody can explain.

If you see them, document with photos and dates, ask for the chart, and get the resident seen by a doctor outside the home. Michigan residents have enforceable rights under the Public Health Code, MCL 333.20201, including the right to be free from abuse and to have complaints heard without retaliation. Complaints go to LARA's Bureau of Community and Health Systems, and to the Michigan Long Term Care Ombudsman, whose advocates visit homes and can intervene without a lawyer. Our guide to Michigan's nursing home abuse and neglect laws walks through both.

When neglect has already caused an injury or a death, the law allows the family to hold the operator accountable, and the fines in the tables above are a useful reminder that the government's penalties do not compensate the resident. Koussan Law handles nursing home negligence cases across Michigan, including a $1.5 million wrongful death recovery for a family in Macomb County. A consultation is free: call (313) 800-0000 or use the contact page. Nothing in this article is legal advice about a particular home or resident.

Method and sources

Every number above comes from one public file: the CMS "Provider Information" dataset for nursing homes (identifier 4pq5-n9py, the August 2026 release, processing date August 1, 2026), downloaded from data.cms.gov and filtered to Michigan. Star ratings, the abuse icon, Special Focus status, staffing hours, turnover, fines and payment denials are CMS's own fields; the fine totals cover the roughly three-year window CMS reports. County and chain figures are simple counts and averages of those fields; averages exclude homes CMS has not rated. National comparisons use the same file. CMS updates the dataset monthly, and the next release is scheduled for September 30, 2026; this page will be refreshed when it lands. Facility names are as they appear in the federal file, with obvious truncations completed. Anyone can reproduce the tables from the same download.