You worry about the quality of care and costs. You've heard the horror stories about nursing homes. And then suddenly you need to find a good one for a family member or friend. Where do you start?

Searching for a nursing home has been made much simpler thanks to the Nursing Home Database, a national directory of every Medicare- and Medicaid-certified nursing home.

Located on the World Wide Web at, this service was established in 1998 by the Health Care Financing Administration, the federal agency that runs Medicare. Since it began, the directory has been visited by 1.4 million people--more than any other section of Medicare's consumer Web site. The service is also available via a toll-free phone number, 1-800-633-4227 (1-800-MEDICARE) for those who don't have access to the Internet or don't feel comfortable using it.

But even the computer-wary should give this Web site a try. It really is easy to navigate, with step-by-step instructions designed to aid even the most inexperienced user. More important, logging onto the Web site is the only way to take advantage of one of the directory's best benefits: the ability to get the latest nursing home inspection reports.

I used this service during a recent nursing home search for my 72-year-old mother. Her health suddenly declined in August and by the end of that month, we desperately needed to find a nursing home bed. I happened onto the Medicare site by chance and found it enormously helpful.

We began with nursing homes in the District. As the scarcity of available beds became apparent, the search expanded to include Maryland, Virginia and Florida, where my parents have a home.

While the Web site directs you to first search by Zip code, I found it more useful to look by city or state. Zip codes need to be exact. Our home Zip code in the District and my parents' Zip code in Florida produced no nursing home listings, yet in each case I knew that facilities existed within a five-minute drive. When I switched to searching by city, many nursing homes appeared on the screen.

By clicking on a box to the left of each nursing home, I was able to select the facilities that I wanted to learn more about. With one more click, I got the option of tailoring the information: I could read a general overview about each nursing home, opt to select more information about the residents in the home or review the latest inspection reports on each facility.

In a few short minutes, I was able to gather an enormous amount of valuable information. The general listings produced a grid that made side-by-side comparisons of several nursing homes easy. Each showed the date of the last inspection, how many beds and types of residents were in each facility and whether it was a for-profit or nonprofit institution. I could quickly see occupancy rates, whether the nursing home accepted Medicare or Medicaid and if it was part of a hospital or a chain of nursing homes. There was even a category indicating whether a resident or family council existed at each facility and a description of what such a council does.

From there it was one click to information about the residents. By checking a list, I could find out how many residents were bedridden, how many needed help in eating, how many were incontinent and other pertinent details.

The Web site then showed the statistics in a color chart and compared the information to national averages and to rates for nursing homes in the Washington area.

In very simple language, the directory also walked me through the background information on each category and explained what it measured and why it was important. For example, it noted that a nursing home with a large percentage of residents who need help in eating requires a lot of staff.

Embedded in this information was a link that allowed me to see state inspection results for various categories, which ranged from the rate of residents with bed sores to the number with unplanned weight gain or loss.

In addition to showing whether inspections have uncovered problems, the reports also go into detail about their scope and severity and indicate whether violations have been corrected. The directory also enables users to see a complete inspection report, rather than just a category-by-category listing.

Perusing the reports provided a very clear picture of nursing homes. Some had isolated infractions regarding food handling, while others had serious, widespread violations involving errors in dispensing medication, controlling infection and other problems that could put patients at risk.

In short order, it became apparent which nursing homes were providing good quality care and which should be avoided. Using this information, we compiled a list of nursing homes to contact and visit. The Web site cautions that all information should be "interpreted carefully and used in conjunction with other sources, as well as a visit to the nursing home." Our experience underscores that advice. Nothing substitutes for seeing facilities firsthand. Visits and discussions with nursing home staff are also essential because the directory does not provide a guide to costs, one of its few flaws.

But the directory gave us a crash course in nursing homes. It also enabled us to quickly target the best nursing homes in our area and then provided the right questions to ask during our visit, thanks to an online guide.

The Web site also lists phone numbers for long-term care ombudsmen and state agencies that oversee nursing homes. It's a one-stop, valuable resource that should not be missed by those contemplating a nursing home for themselves or for a loved one.