I came across this article that shocked me.  Nursing homes in Dallas (where my mom lives) got very low Medicare ratings.  The article is below http://bulletin.aarp.org/yourmoney/work/articles/onethird_of_dallasarea_nursing_homes_get_lowest_possible_medicare_rating.html.

One-third of Dallas-area nursing homes received the worst possible score in a rating system that Medicare unveiled Thursday.

Taking a cue from restaurant and movie ratings, Medicare officials have assigned star ratings to the nation's 15,800 nursing homes based on recent inspection results, staffing levels and a number of quality measures, such as the prevalence of bed sores among patients.

Of the 78 nursing homes rated in Dallas and Collin counties, 25 received only one star, while eight earned the top score of five stars. All ratings are available at Medicare's Nursing Home Compare Web site -- www.medicare.gov/nhcompare.

Nationwide, about one-fifth of nursing homes scored a single star.

"Our goal in developing this system is to provide families with a straightforward assessment of nursing-home quality that draws meaningful distinctions between high- and low-performing homes," said Kerry Weems, Medicare's acting administrator.

Industry officials and consumer advocates agreed that the low scores for many Dallas-area nursing facilities are partly a result of the state's low Medicaid payments to nursing homes. Texas ranks 49th in the daily rate it pays nursing homes for patient care.

Despite increases since 2006, the average daily rate in Texas is still only $112, more than 30 percent below the national average of $162 per day, said Tim Graves, president of the Texas Health Care Association, an industry trade group.

Consumer advocate Suzanna Swanson, who oversees the nursing home ombudsman program in Dallas County, said she wasn't surprised by the high number of one-star ratings, since they're based on state inspections that have turned up many deficiencies.

"If your nursing home doesn't have the money to hire enough caregivers and to train them, the quality of care will suffer," she said.

Still, Ms. Swanson said the state's low funding doesn't let nursing home operators off the hook. Ombudsmen from her program visit every nursing home in the county at least once a month to field complaints and concerns from residents.

"Medicare's new star ratings system may be more user-friendly than the agency's other data, but any family looking for a nursing home still needs to visit several facilities and talk with our ombudsmen about what we've seen and heard," she said.

Molly Shomer, a social worker who helps families coordinate the care of older adults in Dallas, said she will advise her clients to use the star ratings only as a starting point to weed out the worst nursing homes and zero in on the rest.

"Select three or four nursing homes that look good on paper," she said. "But don't put all your faith and trust in the stars. The ratings are only as good as the state inspection teams, and some inspectors are more experienced than others."

Lou O'Reilly, a co-founder of Texas Advocates for Nursing Home Residents, said she considers the stars "too gimmicky" and wishes government regulators and industry executives paid more attention to the hiring and training of nursing home staff.

"It's probably not what anyone wants to hear, but I don't put much stock in ratings," she said.

The data used to determine the new ratings had already been available to the public, but users of Medicare's Web site long complained that they had to pore over page after page of confusing statistics to check on nursing homes.

"What we're introducing is a format much easier for families to understand," Mr. Weems said.

Medicare officials hope the publicity surrounding the star ratings will give low-performing nursing homes the incentive to improve their care so they score higher next time. The agency plans to update its Web site at least quarterly.

While industry officials say they support Medicare's goal, they criticize the agency for working with flawed information.

"Many good nursing homes won't get credit for the job they're doing because of Medicare's half-baked approach to this," said Larry Minnix, president and chief executive of the American Association of Homes and Services for the Aging.

Doctors Health Care and Rehabilitation Center in Lake Highlands was one of the 25 area nursing homes that scored one star, but administrator John Dugan said the low rating doesn't tell the whole story of his facility.

The single star, he explained, is based on government inspections that date back three years, before the nursing home's new owners took charge a year ago and brought in him and other managers to improve care.

"While the data may be technically accurate, it's out-of-date," Mr. Dugan said. "Our most recent inspection was fairly good."

Not everyone has faulted Medicare's new ratings, however.

Kenneth Durand, president and chief executive of the C.C. Young retirement community in northeast Dallas, credited his facility's five-star rating to the professionalism and dedication of his staff.

"We try to take care of our residents' everyday needs, everything from their health care to their outlook on life," he said. "I learned long ago that if you can keep their toast warm in the morning, you've started out on the right foot for the day."