About one in four licensed nursing homes in Dallas County has been cited for serious violations of state and federal standards that harmed residents or put their health and safety in immediate jeopardy.

In Denton County, about one in six facilities had similar deficiencies recorded in their last annual inspection, according to the Texas Department of Aging and Disability Services' Web site. In Tarrant County, about one in seven did. The number was lower in Collin County, where only one of 13 nursing homes had the most serious type of problems.

But most North Texas nursing homes were cited for some type of violation, ranging from failure to treat bedsores to poor recordkeeping.

The numbers follow a national trend recently outlined in a federal study that found that 90 percent of nursing homes in Texas and 91 percent nationwide have been cited for deficiencies.

The report, by the Department of Health and Human Services' Office of Inspector General, found that 17 percent of nursing homes nationwide were found to have the more serious type of problems.

The rate of deficiencies does not surprise advocates for nursing-home residents, who say the facilities overall are under-funded and rely on poorly trained, low-paid employees.

"I think it's appalling that it's that high. That's nine out of 10 homes that are cited for deficiencies," said Suzanna Swanson, director of the nursing-home ombudsman program at The Senior Source, a Dallas nonprofit organization that routinely checks on conditions at facilities.

"These are our elders who have lived long lives contributing to society, and now that's the condition they're living in. They're left in substandard homes with little recourse."

More than 91,000 people lived in 1,175 licensed nursing homes in Texas in August, according to state figures. Experts say such numbers will rise as baby boomers age.

Susan Feeney, a spokeswoman for the Washington-based American Health Care Association, an industry group, said that some nursing homes need improvement, but that the interpretation of nursing-home standards can be subjective. She said potential nursing-home residents and their families searching for a facility should not rely solely on the type of data used in the study.

"It only paints a portion of the picture of what's happening in a facility," Ms. Feeney said. She said families should visit nursing homes before making a decision.

The number of violations at a nursing home can be useful, but another official said it's also important to know the nature of the problems.

"Just saying they had a deficiency is not enough to go on," said Cecilia Fedorov, spokeswoman for the Texas Department of Aging and Disability Services. "Just because somebody had a deficiency doesn't mean it was a deficiency that put the health and safety of residents in jeopardy."

The state agency provides information on nursing-home inspections online. Facilities that have deficiencies must correct them within a certain time period. In Dallas County, 18 nursing homes scored 50 or less out of a possible 100 points in a state rating system. Only one received a perfect score.

The federal study also found that a greater percentage of for-profit nursing homes were cited for deficiencies (94 percent) than nonprofit facilities (88 percent).

NATIONAL REPORT: A recent federal report found that most nursing homes nationwide have been cited for violations of 190 federal requirements. That includes 90 percent of Texas nursing homes cited for an average of 6.5 violations. To read the study, go to www.oig.hhs. gov/oei/reports /oei-02-08-00140.pdf.

SPECIFIC FACILITIES: Information about individual nursing homes' state inspections can be read online. Experts caution that potential residents should also visit a home unannounced and talk to staff and residents before making a decision. For state inspection information, go to www.dads.state.tx.us.

•The Texas attorney general offers advice on choosing a nursing home at www.oag.state.tx.us /elder/select.shtml.

IF THERE'S A PROBLEM: To report violations, call Texas' Department of Aging and Disability Services at 1-800-458-9858.

•To speak to a nursing-home ombudsman, call the state agency at 1-800-252-2412. Or contact The Senior Source, a Dallas nonprofit agency, at 214-823-5700, or go to www.theseniorsource.org.

•Families with questions about nursing homes also can contact Texas Advocates for Nursing Home Residents at 1-888-TANHR4U or go to www.tanhr.org.

SOURCE: Dallas Morning News research