It was one of the hardest decisions that Kathy Fallon ever had to make.

Fallon said, "I had a lot of flack from my family who wanted to keep him home. It got to the point my husband and I could not take care of him anymore."

The decision was to put her dad into a nursing home. But Fallon's first choice wasn't the best choice.

Nursing Home Care Checklist

Fallon said she moved her dad to ManorCare Health Services in Rocky River. But she wasn’t happy with the care being given to the man who cared for her all of her life.

"They had too many people, not enough staff not given the proper care," Fallon said.

But Fallon isn't the only one with concerns about nursing homes.

Working with their partners at Scripps Howard News Service, NewsChannel5 spent three months researching care homes.

NewsChannel5 found poor ratings for a number of Cleveland-area nursing homes. In fact, a quarter of the facilities in Cuyahoga County rated just one star on Medicare's five-star scale.

The facility where Fallon originally placed her dad was ranked a two.

Five other ManorCare properties in the area garnered just one star.

"There should be two kinds of nursing homes the excellent and non existent," said Larry Minnix, chief executive officer of the American Association of Homes and Services for the Aging.

Experts recommend having the difficult conversation with your parent before it becomes an emergency. Also, visit the facility and use all of your senses.

Long-term care ombudsman, Gerald Kasunic, said, "If you smell urine or feces, or what I call the chemical hidden smell, something that may be a serious chemical odor, those are kind of bad signs."

According the SHNS and WEWS study of death records maintained by the Centers for Disease Control and Prevention, nearly 19,000 people died in area nursing homes in 2005 and 2006. Of those deaths, 651 people died of accidents, skin infections or other potentially avoidable causes.

Kathy Loy has walked in the shoes of families having to pick a long-term facility. She placed her mother in a facility and thought she picked the right one. After all, she's been a nurse 34 years and worked in long-term care for nearly half of those years.

Loy said, "I picked a nursing home I thought would be good. She was there 10 days, she lost 12 pounds and I moved her."

Just 14 of the facilities here in Cuyahoga County got the coveted 5-star ranking.

Loy had some advice. She said sit down for a meal.

Loy also said, "Go in on a weekend between two (o'clock) and five (o'clock). See how many staffers, ask to see the staffing board."

For Fallon, she moved her dad to Aristocrat West Rehab and Health Center in Cleveland. It's a 4-star facility. She said it's a world of difference for the man who means the world to her.

"They treat him just like he is their own family," Fallon said.

• Nursing Home Records By County
• Individual Nursing Home Records

ManorCare's Response:

"We support providing accurate information to the public about the care provided in skilled nursing centers; however, CMS' Five Star Quality Rating System fails to differentiate between the levels of care and services provided by the 17,000 plus skilled nursing centers in the United States. The system does not recognize that providers such as ManorCare that provide a very high level of comprehensive medical and intensive rehabilitation should be rated on different criteria than centers who provide a less complex level of care or who operate more as residential caretakers.

The five star rating does not measure the programs and services that go above and beyond basic care. This system does not reflect innovation in facilities such as how well pressure ulcers are healed, whether centers provide pressure ulcer prevention services or how well a center works to reduce pain. The system also does not take into account the professional staffing levels of therapists and nurse practitioners and consultants that may be on board in higher acuity centers. There is no measure for what rehabilitation programs and services are offered to patients which is the reason the majority of our patients come to ManorCare.

We strongly urge all patients and families to use this rating system as only one tool when considering a skilled nursing center. Visiting the center, reviewing patient and family satisfaction surveys, asking about the expertise of the center to handle high-acuity patients or the specific disease or injury, talking to families and patients about their stay, and requesting information on a center’s results in meeting patient and family goals should be an integral part of any admission decision.

Due to patient confidentiality, we cannot discuss any patient who resides or has resided in one of our centers. However, we are disheartened if a family member was not satisfied with our care. We have several systems in place to work with our patients and family members to ensure that we are meeting their rehabilitation goals as well as maintaining their quality of life. This includes an open door policy with our administrative team, on-going staff training that focuses on clinical initiatives and customer services expectations, 800 care line, customer satisfaction surveys and resident and family councils."