Published Mon, Jan 04, 2010 05:00 AM

Families looking for an assisted-living home for a suddenly declining older relative often make that crucial decision in a hurry.

This week, by setting up tougher standards, a state system that has given the top three-star rating to about 95 percent of adult-care centers will become more useful to people under the stress of that situation, officials said.

In 2010, the highest rating for these centers, classed as adult-care homes by the state, will move from three to four stars and will require consistently high performance over two years. In addition, ratings will factor in recent penalties for violations such as medications errors and failure to stop residents from wandering.

That means the top rating will be much harder to come by, state officials and industry representatives said. During the system's first year, which ended Thursday, a large majority of North Carolina's more than 1,250 assisted-living centers and family group homes received three stars, state records show.

"I think that it's going to take this second year before we really know how well it's working," said Lou Wilson, a lobbyist for the assisted-living industry as executive director of the N.C. Association of Long-Term Care Facilities. "There's not going to be as good grades the second year. It's probably going to be truer grades the second year."

The star-rating system was passed into law in 2007 after legislators pushed to provide fuller information on the centers, most of which receive state payments for looking after older people and those with disabilities. Adult-care homes, once typically known as rest homes, are distinct from the more medically intensive and federally regulated nursing homes.

The Division of Adult Care Licensure started issuing star ratings for adult care homes last January, but it didn't take into account previous penalties against facilities for inadequate care before the system started. This year, penalties levied against centers for neglect, unsafe conditions or inadequate care could weigh heavily against them. Other factors include whether the facilities meet standards on staffing, handling residents' medications, training and sanitation.

"When the four stars start being issued, you'll see a truer reflection of the care being provided," said Jeff Horton, head of the state Division of Health Service Regulation, which oversees the centers.

State investigators survey homes throughout the year and post ratings within 45 days, officials said.

Advocates for older people fought for the law, but some have noted that the ratings may sound stricter than they are.

"The ... star rating system is not like a restaurant star-rating system, which gives maximum stars for going above and beyond minimum standards," the group Friends of Residents in Long-Term Care said on its Web site. "This rating system is based on an evaluation of the home's compliance with minimum standards or state rules and is based on a 100-point scale. All facilities start with 100 points."

Wilson, the industry representative, has for years made the case to legislators that adult-care homes do not receive fair compensation given the increasing number of chronically ill residents they look after. Many of the top ratings homes have received in the first year have been deserved, she said.

"The majority of folks that are out there running rest homes are working their rears off," she said. "They are trying their best to stay in compliance with that little bit of money that they have."

Through recent changes in state and county laws and regulations, an older person or a family exploring Triangle choices in assisted living has gained more access to information. But documents and online help should be just part of a search that includes word-of-mouth recommendations and, most importantly, several visits to the home, Horton said.

"Nothing beats being there in person," he said.

thomas.goldsmith@newsobserver.com or 919-829-8929