More than a quarter of nursing homes in the capital area fared poorly in a five-star rating system introduced by the federal government on Thursday.

Only four facilities in Sacramento County garnered the top rating – five stars – while 11 were deemed as "much below average" by the Centers for Medicare and Medicaid Services Agency.

Ratings are no longer just the domain of restaurant and movie critics or travel guides. The government hopes its rating system – available online at www.medicare.gov/nhcompare – will give consumers a snapshot of whether nursing homes have stellar or not-so-stellar performance based on state inspection records, staffing and other measures of quality.

Eskaton, which operates four nursing homes in the Sacramento area, had overall ratings that ran the gamut – from five stars for its Village Care Center on Walnut Avenue in Carmichael to one star for its care center in Fair Oaks. Its two other facilities, in Greenhaven and Carmichael, received three stars.

"It's such a brand-new tool that we're still exploring how the ratings were derived," said Teri Tift, a registered nurse who is Eskaton's director of quality and compliance.

She was not prepared to account for the differences in ratings for its facilities.

"I'm hoping the consumer is fairly smart and will use this as a piece of the puzzle," she said. "I think it could be a wonderful, very valuable tool" for families under stress, she said.

Nationally, just 12 percent of the 15,584 Medicare and Medicaid-certified nursing homes received overall ratings of five stars. Twenty-two percent received one-star ratings.

The remaining two-thirds fell somewhere in between.

The ratings are based on information already publicly available on the Medicare Web site.

"Part of the problem with the information that has been previously available is that it hasn't always been useful, because it hasn't always been very accessible. It was hard to do a comparison," said Ed Dudensing, a Sacramento attorney who specializes in nursing home cases.

He lauded the government's effort to better serve the consumer, but advised caution.

"I think it would be a helpful tool, but only one of the tools," he said of the rating system. "I don't think there's any substitute for going to the facility, walking through the nursing home and using … common sense."

About 1.5 million people live in nursing homes, according to federal officials.

"For thousands of families, we hope this new system will make choosing a home even easier," said Kerry Weems, acting administrator for the Medicare and Medicaid Services Agency, during a telephone news conference.

The number of those seeking nursing home care is sure to rise as a "silver tsunami" of baby boomers begins "lapping on our shore," he said.

The new system got mixed reviews Thursday and came under fire by some critics as incomplete and flawed.

"The five-star rating system is a great idea, prematurely implemented," said Larry Minnix, who heads the American Association of Homes and Services for the Aging.

He called the rating system "poorly planned … and ham-handedly rolled out."

While the rating system can be used as a tool, officials advised consumers against using the rating system as their only decision-making criteria.

"This should help consumers in narrowing their choices, but nothing should substitute for a visit to a nursing home when making their decision," Weems said.

He hopes that poorly rated facilities "will try to understand why they are in the lower end, and use this to improving their quality," adding that the rating system should prompt consumers to ask the same questions.

Facilities with few stars shouldn't automatically be dismissed, officials said.

"Surely, most of us when we consider a movie or a restaurant, we don't just consider the number of stars. We read the review," said David Sayen, the regional administrator for the Centers for Medicare and Medicaid Services Agency in San Francisco.

Sayen urged people to use the ratings as an entry point for investigation. Facilities could change, for better or worse.

Visit the nursing home to see firsthand the condition of the facilities, to feel out the attitude of staff. "Is it clean? Do people look like they're being cared for? Are they being given meaningful activities?

"What we hope people will do," he said, "is to take a more active role in studying options available for health care."

Call The Bee's Bobby Caina Calvan, (916) 321-1067.