Wendy Reardon has a hard time fighting back tears as she watches her father play his keyboard for fellow residents at The Laurels of University Park nursing home.

A few months ago, he was in a different nursing home where he was recovering from shoulder surgery after falling. From day one at the other facility, she said, there were problems.

"I was told he was supposed to see a doctor within 48 hours of going into the nursing home. It took 10 days," said Reardon.

"He got no painkillers for seven days with a broken shoulder," she said. He was not eating. When she was asked about another medication her father was taking, she said she was told they had run out of it. She complained, she said, and people promised to do something, but nothing changed.

"One day I came in, he was lying flat in bed, his food tray was on the bed. Nobody helped him sit up," she said. Her father, legally blind and with hearing aids in both ears, has never been the type to make a fuss, she said.

Eventually, because he was not eating, David Blassberg, 90, lost so much weight he was hospitalized to have a feeding tube inserted and to have a blood transfusion. By then, Reardon had already started looking for a different nursing facility for her father.

"I was so angry about him going into a nursing home to recuperate and he almost died in there," said Reardon."

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About 1.5 million Americans live in an estimated 16,000 nursing homes. By 2050, according to an Alliance for Health Reform analysis, as many as 12 million people age 65 and older in the United States will need long-term care, which includes nursing-home and assisted-living care. The federal Centers for Medicare and Medicaid Services, which pays for much of the nursing home care in the United States, is stepping up efforts to police nursing homes.

In February, the Medicare agency released a list of 4,037 nursing homes "targeted for improvement" because of use of restraints and patient bedsore rates. In addition, CMS has released a list of the worst nursing homes based on repeated problems identified during licensing and complaint inspections. Called "special focus facilities," these places "have a yo-yo sort of compliance pattern," said Joani Latimer, Virginia long-term care ombudsman.

Three Virginia facilities are on the agency's "worst" list -- Beacon Shores Nursing & Rehabilitation in Virginia Beach, Ruxton Health of Woodbridge, and Harbour Pointe M & R Center in Norfolk. Sixty-one are on the restraint and bedsore list.

CMS also provides consumers a resource on the Web to check nursing home quality. That site, www.Medicare.gov/NHcompare, summarizes information from licensing and complaint inspections.

"The information on the Web site is not comprehensive, and it's not as up to date as it needs to be for consumers to make a good decision," said Latimer. "The quality of care in a nursing home can change sometimes as rapidly as with a change in administrators or in significant staff."

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The first nursing home David Blassberg stayed in is not on the CMS list of poor-performing homes. Nor was Seven Hills Health Care Center, a facility run by the Hospital Authority of Richmond. Seven Hills officials in November decided to close the nursing home after a string of bad inspections resulted in loss of eligibility for Medicaid and Medicare funding. Losing the federal funding is one of the most severe penalties a facility can face.

"We are always concerned when a nursing home closes," said Janet Wells of the Washington-based National Citizens' Coalition for Nursing Home Reform. Residents may be transferred to a facility that is no better.

"We would rather have them require the nursing home get better," said Wells.

Virginia's nursing home quality overall in 2006 was rated "very weak" in a report prepared by the federal Agency for Healthcare Research and Quality. The rating, based on how the state stacks up to other states, is determined by information collected by Medicare.

Nationally, an estimated two-thirds of nursing homes are investor-owned. Dan Frith, a Roanoke attorney who has handled lawsuits against nursing homes, said the biggest problem with nursing homes is staffing.

"They are understaffed. The staff are typically poorly trained and poorly compensated," said Frith. "Some states have minimum staffing requirements . . . Virginia does not have that."

State legislators have tried. For at least the past half dozen years, bills introduced in the Virginia General Assembly would mandate staffing levels in nursing homes. It would come at a price -- and the Virginia Medicaid program would have to bear a lot of it.

"I think it was around $40 million this year," said Steve Morrisette of the Virginia Health Care Association, a group that lobbies for nursing-home interests.

"The pool of potential caregivers -- CNAs and licensed nurses -- is just not that great. I am not sure even if we had the money to hire them, we could actually find them," said Morrisette.

For the first nursing home her father was in, Wendy Reardon said she had relied on the recommendation of hospital staff. Faced with his deteriorating condition, she started looking for a different facility. She learned about The Laurels, in western Henrico County, from staff at an assisted-living facility where her father had lived previously.

"The most important thing is to educate the family member who is trying to make the arrangements. You need to find out everything you can," said Reardon.

"My advice would be to push the social worker if you go and see the facility and are not crazy about it," she said.

Reardon said she has no plans to sue but has thought about writing a letter of complaint to the first nursing facility where her father stayed.

"It might have been because of my stupidity or lack of knowledge. I did not know what to do," she said. "The second time he came out of the hospital, after a second stay, I talked to the doctor. I found out what he was going to do, what medication he was on. I did not leave it up to chance."

The difference between the two facilities is like night and day, said Reardon. Her father is thriving, so much so that his impromptu keyboard performances have evolved into weekly concerts. During a recent performance, Blassberg, dressed in a crisp white shirt with a black bootlace tie, black pants and a belt with a big silver buckle, played for about an hour.

He does Lawrence Welk tunes, Reardon said. He corrected her. They are Welk-era tunes.

"I play the same era," said Blassberg. "Tunes of the '30s, '40s and '50s."

"What was frustrating to me is I was there every single day. I was an advocate for him," said Reardon. "And I thought about the people who didn't have anybody there."