A National Medicare survey ranks four Jersey Shore nursing homes at the bottom of its list of 33 facilities in the Garden State.

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Manchester Manor Rehabilitation in Manchester, Rose Garden Nursing and Rehabilitation Center and Shore Meadows Rehabilitation and Nursing Center, both of Toms River, and Gateway Care Center in Eatontown all received the lowest rating, one star, according to the Asbury Park Press. All are for-profit facilities.

New Medicare information released shows two Ocean County nursing homes that garnered one star ratings for three years have improved to four out of five stars. The facilities are Holiday Care Center in Berkeley Township and Hampton Ridge Healthcare and Rehabilitation in Toms River.

Ocean County has seven, five star facilities, while Monmouth County has nine.

The rating system is based on health inspections, staffing and quality measures.The Nursing Home Compare website is updated monthly. To see the results go to http:www.medicare.gov/nursing home compare.