Nursing homes in Howard County rated

Living in Howard County we seem to take for granted that we have the best of everything.  Top schools, great library, good government and highly ranked community.   So it was a little unsettling to look at the scoring of  Howard County nursing homes that was recently shown in the US News and World Report.  Apparently US News is involved in ranking more than just colleges.  As they explained how their rankings of nursing home were determined:

       "The data behind Best Nursing Homes come from Nursing Home Compare, a website run by the federal Centers for Medicare & Medicaid Services. CMS sets and enforces standards for nursing homes enrolled in Medicare or Medicaid, as most are. The agency also collects information from states and individual homes and assigns each home (other than a few too new to have built up enough months of data) a rating of one to five stars in each of three categories:

1) State-conducted health inspections

2) Nursing and physical therapy staffing

3) Quality of medical care"

       Selecting a nursing home for a relative can be challenging.  Often it is a decision that has to be made quickly, often before the relative is discharged from a hospital.  With little time to visit many nursing homes the decision is often made in an uninformed manner.  The online link from US News to Baltimore area nursing homes is a place to start in making that choice.
       We have 3 nursing homes in Howard County.  The nursing home unit at Vantage House is part of their continuing care facility and only available to residents of Vantage House.  It has a strong top 5 star rating.  Unfortunately that is not the case with the other two nursing homes in the county.  The Lorien Nursing Home only gets a 2 star rating.   Interestingly the other nursing homes that Lorien runs in other communities rate higher than the one in Columbia.  Even worse is the dismal rating of the Ellicott City Health and Rehabilition Center.   It gets the lowest score of 1 star and is being closely monitored because of its history of bad care.
       The question I have to ask is why with our expectations of high quality in our county institutions we seem to have nursing homes with such poor quality?