The www.medicare.gov website ranks nursing homes with a system that gives a 5-star rating for the highest, and a 1 star for the lowest.
Our investigation showed nearly 50 percent of the nursing homes in central North Carolina's biggest counties - Wake, Durham, Johnston, and Cumberland - are providing poor service.
That means inspectors determined conditions may be unsanitary and could put patients health and physical well-being at risk at nursing homes that receive Medicare funding - which is taxpayer dollars.
Janine Maves told ABC11 she's angry about the care she said her mother got at one of Raleigh's top-rated nursing homes. She died six months ago at Kindred Transitional Care and Rehabilitation, formerly known as Sunnybrook.
"It just broke my heart. It was just so sad to see her not getting the care she needed, the care she deserved," Maves offered.
Maves told ABC11 she took special care in picking the best nursing home for her mom, and used the top federal resource for evaluating nursing homes: www.medicare.gov. Maves said the website had a good rating for Kindred.
"At the time, it had 4 stars on the rating system that Medicare keeps," she recalled.
But our investigation showed Maves didn't get the full picture of the nursing home's past problems. We looked into previous inspections at the home - formerly known as Sunnybrook Healthcare and Rehabilitation.
We discovered that two years before Maves admitted her mother, the state fined the nursing home more than $206,000 for allegedly putting residents in "immediate jeopardy to health and safety". The fine was based on an investigation of abuse allegations.
The daughter of 88-year-old resident Della Jarrett said her mother had bruising on her body. Investigators could not substantiate the claims, but did not rule out abuse could've happened.
The I-Team obtained a document which shows Medicare reduced the fine by 35 percent because the nursing home waived its appeal rights. We checked and found Kindred Sunnybrook paid its penalty. The I-Team also obtained a copy of a 2009 state investigation at the nursing home. It includes a number of violations - or what Medicare calls deficiencies - and what administrators did to correct them.
It's important information Maves said she never saw.
The report is 76 pages long, but the only evidence of the investigation we could find on the www.medicare.gov website are a few generic complaints documented by investigators.
We called the Centers for Medicare and Medicaid and were told reports like the one we obtained were not included on the website until July of this year.
That's no consolation to Maves. She told us if she had known that she would not have sent her mother to Kindred-Sunnybrook.
She recounted her experience with her mother at the home.
"My mom kept complaining that she had frostbite on her feet - that she was so cold - and I took off her socks and found this black spot," Maves recalled.
"The doctor who oversaw all the patients at the facility said that it was a blood blister from an ingrown toenail, and that ... we just had to wait for it to heal up," said Maves.
"The spot continued to grow ... and Mom was in terrible pain," she continued. "It was gangrene. And after a few weeks, the nurse and the doctor admitted that it was gangrene and that it was growing."
Maves filed a complaint about how she says her mother was treated with the State Department of Health and Human Services. But an investigation found her claim was unsubstantiated due to a "lack of sufficient evidence."
The I-Team analyzed the star ratings at other area nursing homes that are paid with Medicare money. We looked at four counties: Wake, Durham, Johnston and Cumberland. We found nearly half of them fall below the average inspection rating for health, staffing, and quality.
We also discovered serious violations at some of the nursing homes we analyzed, like failure to secure a resident during a transport resulting in a fall, and room temperatures between 40-50 degrees causing a resident to get hypothermia - who died days later, failure to report abuse when a resident was found with bruises, and failure of nurses to properly clean residents after they wet themselves.
We went to Carmelita Karhoff who is a nursing home ombudswoman for Durham County who helps senior residents and their families when they're having problems.
"It is a civil right for them to be provided that care and service," she said. "As it relates to nursing homes that avail themselves of Medicare monies, they are responsible, according to the Nursing Home Reform Law, to provide the care and service that helps the residents attain or maintain their highest possible physical, mental and psychosocial wellbeing."
And when a nursing home doesn't, it can lose its accreditation with the Medicare system. But, in North Carolina, that's rare. The nursing home is more likely to fix the violations cited by an inspector in order to stay in business, keep residents, and get a better rating. But even when it does, you may not know about those changes immediately on the medicare.gov website.
Bob Konrad is with the advocacy group Friends of Residents in Long Term Care. He told us sometimes the Medicare website doesn't provide the most accurate information for caregivers.
"A facility can deteriorate quite quickly given that you have very high turnover," he explained. "The staff of RN and LPNs, and perhaps the most importantly, the frontline workers, the nurse aids can turnover very quickly."
"It just takes a long time for some of those indicators to make it through the system," he said.
Kindred's Rose Manor in Durham is a 5-star nursing home and has won many awards for quality and service. Its management told us:
"While a five-star rating system is a useful tool for comparing nursing homes, there is no substitute for visits to nursing facilities and face to face discussions with caregivers."
Janine Maves agrees that you need to do your homework. She told us she feels let down by the government rating system that she counted on when her mother needed a nursing home.
Kindred Sunnybrook did not return our phone calls but sent a statement:
"Resident Care and safety is our number one concern. We are pleased that for two years in a row, we have had deficiency - free surveys and that we have a five-star rating from the Centers for Medicare and Medicaid Services. This is possible because of the hard work and dedication of our staff and their commitment to providing the quality care our residents deserve and expect."
There are about 38,000 nursing home residents in North Carolina. Most of them depend on Medicare to pay part or all of patient's bills. We tried to ask Medicare why it takes so long to update its website and doesn't require nursing homes that are paid with taxpayer dollars to provide the highest quality care or risk getting cut out of the program. Medicare refused to grant us an interview and refused to answer those questions.