OVERLAND PARK, Kan. (AP) — Fred Rich did not check Medicare's ratings for nursing homes before he picked one in Overland Park last month after breaking his back.

The 71-year-old from Kansas City now says that doing so might have saved him a lot of frustration.

"The absence of staff, particularly well-trained staff, competent staff, makes it a very difficult place to live," he said.

Had Rich gone to the federal Nursing Home Compare website, he would have found rankings for nursing homes along with inspection information. The Star has analyzed the data and provided it in a searchable form.

Homes are rated by Medicare in four areas: Overall staffing levels, percentage of registered nurses, state inspections and quality measures like how many residents get flu shots or keep their weight up. It gives homes a separate rating in each area, then combining them into an overall rating.

The homes are graded on a curve. The top 10 percent of facilities in each state get five stars, the bottom 20 percent get one star and those in between get two, three or four.

The home Rich chose received one star.

Nursing Home Compare is a treasure trove of information for people in search of the right place for loved ones, but even those who work at the highest-ranked facilities say it shouldn't be the only factor when picking a home.

"I think it's too simple to boil things down to just one overall rating," said Steven Seggerman, the CEO of Bishop Spencer Place in Kansas City, which has had a five-star rating since 2012. "Obviously, I'm pleased our community has (five stars). That's great and we want to tout it, but I also don't want to think it's the end-all."

Seggerman said a surprising number of people who come to check out his facility tell him it's because of the star rating.

Critics say the information is not perfect: Two-thirds of facilities' overall score is based on self-reported data on staffing and quality. The remaining one-third of a facility's score is based on state inspections, that, while more objective, can also be outdated. Kansas is behind schedule because of vacant inspector positions.

The overall rating is just a place to start, said Mitzi McFatrich, the executive director for Kansas Advocates for Better Care, a nursing home watchdog group.

One of the most important factors to consider is staffing: Are qualified medical professionals available at all hours of the day? And one way to check — in addition to the website — is to visit the nursing home in person, McFatrich said.

"Pop in when people are having lunch or getting up in the morning, and pop in overnight and the weekends because that tells you a lot about staffing that's available all the time," she said.

On the Nursing Home Compare website, people can view yearly inspection reports. People can also request those reports in person from the nursing home itself.

While looking at the inspections, look for the words "abuse," ''neglect" and "jeopardy," and if you see something of concern to you in an inspection, ask the administrator to explain exactly what they've done to correct it, McFatrich said.

"Look for a three-year history," she said. "The state (Kansas) is 15 to 24 months behind in inspections. It's very problematic. It means facilities aren't correcting practices in a timely manner."

In Missouri, just one nursing home received a perfect score of five in all star rating categories: The Manor at Elfindale in Springfield.

The highest ranked nursing homes in Kansas City were Bishop Spencer Place, Kingswood and Hope Care Center.

Hope Care Center is one of just a handful of nursing homes in the country that specializes in patients with HIV and AIDS. It sits on nine acres in the Waldo neighborhood, where it's been since 1996.

In Kansas, five nursing homes received a perfect score of five overall and in all four categories: Lakeview Village in Lenexa; Bethel Home in Montezuma; Cumbernauld Village in Winfield; Larksfield Place in Wichita; and Medicalodges in Columbus.

The ratings apply only to skilled nursing facilities, not to assisted living or senior apartments that provide lower levels of aid.

Bryce Turville, 91, moved into Lakeview with his wife in 2005. He said the skilled nursing facility there offers a broad range of exercise options, including isometrics, and staff members are quick to address any concerns he's raised.

"You'd be surprised how quick the response is," Turville said.

Rich, a retired attorney, said he's had the opposite experience at Serenity Rehabilitation and Nursing in Overland Park, one of the lowest-ranked facilities in the Kansas City area. He invited a Star reporter to visit him and see firsthand on a recent Friday afternoon.

Rich had just returned from a physical therapy session. A physical therapist assistant had wheeled him back to his room and both of them were waiting with his nurse call light on because the assistant could not transfer Rich from his wheelchair to the bed without help. After 15 minutes with no response, the assistant left and got a wound care specialist to help.

Then Rich waited 30 minutes with his call light on for someone to come clean him up.

"They just aren't well-staffed enough to really help you," Rich said.

The Serenity facility in Overland Park was among the bottom five rated nursing homes in Kansas. Another facility owned by Serenity in Missouri was the lowest ranked in Missouri.

The on-site administrator of Serenity's Overland Park location did not respond to a request for comment. The Star received a response days later from the public relations director for Centers Health Care, a nursing home chain based in New York City. He said his company has a consulting agreement with the Serenity nursing home group.

"Since Serenity Care Group took over the Overland Park, Kansas City and Butler facilities in May of 2017, major changes have been taking place at those locations that are not reflected in the latest Medicare star ratings," he said in a statement attributed to a company spokesperson.

The statement went on to say that the company had increased rates of successful rehabilitation at the facilities, while decreasing hospital re-admissions. It also said the company has hired new leadership and worked down the percentage of temporary agency staff at the Kansas City and Overland Park locations from 70 percent to 10 percent.

While the Serenity homes in Overland Park and Kansas City got poor marks for staffing and health inspections, those inspections did not reveal any problems that caused "widespread immediate jeopardy to resident health or safety," which is the most severe deficiency Medicare tracks.

Medicare can fine individual nursing homes for not meeting standards. Overall, Kansas nursing homes had the eighth highest total of penalties from Medicare since 2014 at nearly $7.5 million. Missouri nursing homes had the 18th highest total nationwide at nearly $4.7 million. Texas, which has more nursing homes than either state, had the highest total penalties at nearly $19 million.

Nursing Home Compare has its critics.

A study published by Florida Atlantic University researchers in January found that at least 6 percent of homes, when self-reporting data on staffing and quality, have overinflated their numbers to make themselves look better.

Inspectors are supposed to get to every facility at least once every 16 months. Missouri has been hitting that mark, but Kansas has not because the state is short on inspectors and those it does have are required to prioritize inspections based on complaints above the routine check-ins.

As of Jan. 25, 18 of Kansas' 66 inspector positions were vacant and it was taking the state an average of 17.43 months to get all of its hundreds of skilled nursing facilities inspected.

Cindy Luxem, the president and CEO of the Kansas Health Care Association, said that means the Medicare ratings don't necessarily reflect more recent improvements homes may have made.

The Centers for Medicare and Medicaid Services are also in the midst of revamping their state inspection rules. Because of that, the federal agency has decided to freeze the state inspection portion of the Medicare star ratings for 18 months starting last September.

Rachel Monger, the vice president of government affairs for LeadingAge Kansas, which represents non-profit nursing homes, said that means homes that have had a good inspection since then won't see the boost in their star ratings that they deserve.

"And of course, the freeze will benefit any homes that have had a poor survey since September, because that will also not be included on their Nursing Home Compare score," Monger said.

Monger and Luxem both said that the best course of action for those looking for a nursing home is to take the ratings with a grain of salt, visit facilities in person and interact with management and staff.

"It doesn't matter if you are online looking at a one-star or a five-star home," Monger said. "There is no star that can substitute for your own evaluation and judgment."

Diane Diedrich went looking for a nursing facility in Kansas City for her parents a few years ago.

Although she's a retired nurse, she wasn't looking for anything particularly technical or clinical. The signs of a good facility versus a bad one were things anyone could spot.

"Some of the places didn't seem particularly well-staffed or friendly and they, quite frankly, smelled terrible," Diedrich said.

Diedrich's parents ended up at Bishop Spencer Place, a mid-sized facility between Westport and the Country Club Plaza.

The family has been happy with the care they've received there. Diedrich's smell test was vindicated by the Medicare ratings that rank Bishop Spencer as one of the top nursing homes in Kansas City.

___

Information from: The Kansas City Star, http://www.kcstar.com