More than half of nursing homes in the Roanoke region are "below average," according to a new federal government rating system that made its online debut last month.

Only three of 27 nursing facilities in the region stretching from Bedford to Pulaski earned top honors, or five stars, from the "Nursing Home Compare" Web site managed by the Centers for Medicare & Medicaid Services, while nine earned the lowest ranking of one star and five others earned just two stars. That means, for the area's nursing homes 11.1 percent earned five stars and 33.3 percent earned one star.

Nationwide, 12 percent of nursing homes earned five stars, while 22 percent scored one star. Statewide, 11.6 percent of Virginia nursing homes earned five stars, and about 32 percent earned one star.

While all facilities meet government regulations to bill for Medicare or Medicaid services, facilities with one or two stars are considered "below average," according to the government's definition of the star rankings.

The star system ranks facilities based on state inspection reports, staffing information and quality of care measures. While the information was already publicly available, the often-used consumer rating system applied to the entertainment and travel industries make the data more easily interpreted by the public.

It's a consumer tool Congress pushed for, and a system that some nursing home advocates say can better inform individual decisions about which facilities to select or avoid.

"People should use this as one of many tools in selecting a nursing facility," said Pam McAdams, long-term care ombudsman at the Local Office on Aging's Area Agency on Aging. "People still need to consider things like location. Location is very important so family can monitor the quality of care their loved one is receiving."

Families shouldn't rush to move someone out of a one-star facility, she said.

"So what if they got one star, if you are living there and you feel like you are receiving appropriate care and the staff is considerate to you, I don't think you need to leave," she said.

While five stars doesn't exactly equate to staying at a luxury hotel and one star isn't equivalent to a no-frills roadside motel, the star system does account for the quality of care patients receive. Those with more stars offered more nursing staff hours per patient, and scored high marks on unannounced inspections and various health quality indicators

It's the access to information that has Roanoke elder-law attorney Dan Frith convinced the tool is needed.

"I think its something that's kind of long overdue for the consumer out there," Frith said. "It gives a very accurate picture of which facilities are likely to provide good care."

Still, many in the nursing home industry say the system is flawed. Even local administrators who earned the accolades of a perfect five stars say that those living in one-star facilities are likely receiving good care.

"To me, the ratings quite possibly are giving folks in the community a false impression," said Keith Denson, administrator at Snyder Nursing Home in Salem. "There are a lot of good people out there right now and the grade that is being presented is not what they are worthy of."

Snyder was one of the local facilities to earn five stars. The others were Brandon Oaks Nursing and Rehabilitation Center in Roanoke and Radford Nursing and Rehab.

Joe Hoff, the administrator at Brandon Oaks, said while he's proud of the number of stars his facility received, he is more concerned with Brandon Oaks' overall reputation.

"It's definitely a tool to use, but really it is just another way to educate people," Hoff said of the stars. "The bigger thing is customer satisfaction and listening to word-of-mouth."

While Hoff said he has had a handful of people ask about Brandon Oaks' high mark, many residents said they made the choice based on recommendations from others.

"I was looking for professionalism, and I found it here," said Barbara Thompson, whose husband, Robert, is staying at Brandon Oaks while he recovers from a knee replacement surgery. "I didn't need anyone to tell me this is five stars, because you can see it. It is definitely five-star treatment."

Thompson said her husband's physician recommended Brandon Oaks for the rehabilitation.

The size of the facility and severity of the health problems facing the patient population is not taken into account. That means those nursing homes with smaller, healthier populations have the advantage in meeting many of the health quality standards used in the rating system, industry experts said.

With 343 certified beds, Friendship Health and Rehab Center is one of the largest facilities in the area. It was also among the area nursing homes that earned just a single star.

"If you rely too heavily on just the stars themselves, it's an oversimplification," said Stan Huffman, Friendship's chief executive officer. "Even if you look at CMS's Web site, they caution people as well to not read too much into the star itself without looking at the data."

A look at the data reveals that state inspectors found 13 problems during an unannounced visit in June, none of which put patients in direct harm. All have since been corrected, Huffman said.

In comparison, Snyder has 45 certified beds and no problems were found during its last state inspection in September 2007. Brandon Oaks, with 62 certified beds, was cited for one problem during its inspection in August.

Additionally, Huffman said Friendship's commitment to taking care of patients on dialysis and to providing a specific palliative care program means they attract residents with more complex health care issues that can be more difficult to treat and lead to lower health quality scores.

One thing everyone agrees on is that people can learn the most about the quality of care by visiting the nursing home.

"We encourage anybody to visit the facility," Huffman said. "Talk to the staff and talk about what their specific needs are that need to be fulfilled and find the best facility that meets their needs."

When making the decision, nursing home advocates, facility administrators and others recommend taking a facility tour and asking a lot of questions.

"Firsthand experience speaking with friends who are residents and staff, and other friends and family is the best source of information," Denson said. "It is the toughest decision that a lot of folks will ever make and to use just one tool to formulate that decision may be unfairly judging folks."

Continuing to visit the facility at various hours of the day and throughout the week (including on weekends and holidays) is the best way to ensure residents receive quality care, McAdams said. And if something doesn't seem right, speak up, she said.

McAdams fields about 40 calls a month helping families to understand what expectations are valid and how to address situations where care is substandard.

Attorney Frith suggested that anyone concerned with a facilities rating should ask to have a meeting with the administrator and the director of nursing.

"Let them know, 'I'm aware of the rating,' and ask, 'Can you tell me what steps are you going to take to improve your rating and when will those steps be taken,' " Frith suggested.