A Guide to Choosing a Nursing Home

Discovering the best match requires exploring locations, learning about a community’s culture, and finding a nursing home that offers personalized care, meals, and activities, says senior care professional Mark Pavlovich, owner of Yardstik Behavioral Analytics and chair of the workforce and customer experience committees at the American Health Care Association.

By understanding top characteristics to look for when touring, you can ask the right questions and simplify your search.

Often, there can be a lot of family guilt associated with moving a loved one into nursing homes, says Pavlovich. “It’s important to be prepared, and although it’s not always easy, you have to do what’s best for your loved one.”

First, determine your loved one’s needs, priorities, and concerns.  It can be helpful for families to perform a self-evaluation and ask:

• What kind of care or services does my loved one require?
• Are there any amenities my loved one cannot comfortably live without?
• What’s our family’s budget for care?
• What kinds of activities are important to my loved one?
• Which city or state does my loved one prefer to live in?
• Does my loved one have any concerns or worries about moving?

Personalization and cleanliness are two important factors, but there are many others to consider, says Pavlovich.  Families can make the decision-making process easier by taking tours, speaking to staff, and evaluating and comparing the following features in nursing homes.

Medical services

Nursing home services differ greatly around the country. If your loved one requires speech therapy, for example, but also has diabetes, or requires special assistance managing their diet, can the community tend to all of their specific needs? Find a community with a level of care that caters to your loved one’s unique requirements.

Medical services generally include:

• Wound care
• Physical, speech, or occupational therapy
• Injections
• Catheter care

Additional services include:

Let our care assessment guide you

• Medication management
• Assistance with bathing, dressing, and other activities of daily living
• Help with hygiene or grooming
• Assistance with eating

Evaluate cost and amenities

It’s important to know the cost of nursing home services and whether they fit your budget. In addition to care, be sure to find out what is — or isn’t— included in the cost. Families sometimes receive bills for services they didn’t know cost extra, says Pavlovich.

Although amenities like beauty salon services, podiatry services, or group outings are a plus, they typically cost more.

When exploring communities, be sure to ask:

• How is the pricing structured?
• What’s included in the cost per month and what costs more?
• Does the price change annually?
• Is the nursing home certified by Medicare or Medicaid?

Any nursing home that receives money from the government should pass an inspection by the Centers for Medicare and Medicaid Services. If a nursing home fails to pass inspection, it’s not certified. If applicable, ask the nursing home for their inspection report or certification.

Assess staff members

Nursing homes provide a high level of on-site care, with staff supervision 24/7. Care providers include doctors, nurses, therapists, dietitians, certified nursing assistants, and more. Since staff is around or near residents at all times, it’s important to learn about their professional experience, problem-solving skills, training, and involvement with residents.

Pavlovich suggests asking personal “what if” questions that pertain to your loved one. For example, if they exhibit dementia behavior — wandering, acting out, or showing anger — how can staff deescalate difficult situations or manage these behaviors? If your loved one is a picky eater, can staff find alternatives or solutions to ensure they’re still able to eat a healthy and balanced diet? 

Finding staff members that go the extra mile in getting to know your loved one can make a big difference in their quality of life in a nursing home. If you’re walking by rooms on a tour, ask staff if they’re able to share any fun facts about residents, says Pavlovich. “It’s important for them to know more about a person than just their health condition or disease,” he says.

Additional questions for staff may include:

• How often do physicians check on residents?
• How many nurses are available during the night and day?
• Does staff provide regular updates to families?
• Can a resident’s family physician check on them?
• Is there a high staff turnover?
• Are background checks given to employees?
• What’s the community’s policy on using anti-psychotic medication?

Discuss care plan strategies

Learning the ins and outs of care plans can ensure your loved one is in good hands both now and in case their health changes. When evaluating nursing homes, find out who creates, updates, and manages regular health care assessments.

Key questions about care plans include:

• When and how often are care plans updated?
• Who is involved in managing or creating care plans?
• If my loved one’s health changes, who contacts or shares this information with family members?

Look for key safety features

Safety is imperative to residents’ and families’ peace of mind. Leitson suggests evaluating the building’s security and asking how features can protect residents or alert staff of potential issues. For example, do you notice codes or locks on the doors? Do you notice uneven flooring or rugs that could potentially cause someone to fall? Are the fire exits clearly marked?

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Additional safety questions include:

• Are emergency plans in place for fires or natural disasters?
• How are emergencies handled for immobile individuals or those in wheelchairs?
• Are elevators or handrails installed in the building?
• Is the building well-lit and easy to see around?
• How are visitors screened before entering?
• Are there emergency buttons in rooms or pendants for residents and staff?
• How close is the nearest hospital?

What are the activities like?

It’s common for nursing homes to offer group or personalized activities for residents. If your loved one has specific hobbies, be sure to ask how communities learn about their interests, get to know them one-on-one, and engage them.

“Always look for a meal board with alternatives, as well as community activities,” says Pavlovich.  “If it doesn’t include three to four activities, seven days a week, it’s usually not a good sign. There should be a variety of activities for everyone — not just bingo — such as pet therapy, Monday Night Football, reading, arts and crafts, and more.”

Important questions to ask about activities include:

• How often do activities occur?
• Who plans the activities?
• Are families able to join or attend activities?
• How are activities personalized for residents?
• Can residents suggest activities?
• Are activities planned outside of the nursing home?

Take a tour and use our nursing home checklist

One of the most personal ways to gain a clearer understanding about how a community can help your family and loved one is to visit unexpectedly or call.

Prepare questions beforehand, take notes, and use your observations to compare communities to find the perfect fit. Pavlovich suggests asking the first person you see when you walk in to take a tour, and highly recommends visiting during meal times if possible to observe resident and staff interactions.

Ask yourself while touring:

• Do the residents seem happy?
• Are staff members friendly and approachable?
• Does the community appear clean? Is there anything on the floor?
• Are the bathrooms tidy?
• Are there any noticeable safety hazards?

Ask staff while touring:

• What kind of food is offered? Is there a sample menu?
• Is there any religious or cultural support?
• Does the nursing home meet local or state licensing requirements?
• What are the community’s visiting hours?
• Are residents able to decorate or personalize their rooms?
• Are residents able to have roommates?
• How many residents are in the building?

When evaluating potential nursing homes, Medicare’s Nursing Home Compare Tool is a useful reference. It provides an easy way to compare nursing homes in your area. Begin by entering your ZIP code to select and compare nursing home quality ratings, health inspection details, and more.

Make the best senior care decision