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How To Choose the Right
Nursing Home
Knowing how to choose the right nursing home is essential for people seeking long-term care and their loved ones who are searching for placements. You have the right to expect that potential nursing homes meet standards of care and provide an environment where residents are comfortable and safe.
What makes the “right” nursing home isn’t black and white. Determine what you are looking for, research potential options, and ask questions to determine the best fit. Watch for red flags that tell you a facility may not be a safe place to call home.
What To Look for in a Nursing Home
Looking for a nursing home can be overwhelming, especially if the need comes on suddenly. You can develop a nursing home checklist tailored to your or your loved one’s needs and use it as a starting point. Some factors to consider include:
Location and Accessibility
Look for facilities near family and friends to facilitate frequent visits. Additionally, consider proximity to hospitals and personal doctors. Walkability to shops and parks and proximity to public transportation, if using it is an option, may also be worth considering.
Services and Amenities
Confirm that the facility provides necessary services, such as physical or occupational therapy, Alzheimer’s care, or mental health support. Beware of the “chandelier effect,” where nursing homes focus on the appearance or amenities of the facility rather than the standard of care. Higher prices, lavish facilities, and fancy decor don’t necessarily translate into better or safer services.
Cost
Medicare generally doesn’t cover long-term nursing home care, but you may qualify for low-income-based Medicaid to pay for a nursing home. Medicare provides a list of long-term care resources to help you plan, find additional insurance, or identify ways to offset costs.
Quality of Care
Use online resources to find state inspection reports and ratings. Look for essential care factors, such as staff-to-resident ratios, staff credentials, food quality, and infection control. If you visit a facility, observe interactions between staff and residents and look for quality of life factors, such as staff response time, room conditions, and opportunities to interact with others.
Licensing and Certification
Do not consider a facility that is not licensed and certified by the appropriate state and federal agencies. State licensing information is generally available through the local Department of Health, Department of Aging, or other similarly-named agency.
Reviews
Sites like Facebook, Google, and Yelp often have nursing home reviews. However, to get a complete picture of a facility, only use them in conjunction with other research tools.
Some sites allow nursing homes to delete reviews. In other cases, a few very good or very bad ratings can have an oversized effect on what are generally good overall ratings.
Research Tools When Considering Nursing Homes
There are several online tools you can use when considering homes, including:
- Medicare’s Nursing Home Compare Tool includes ratings, inspection reports, staffing levels, fines, and quality measures.
- U.S. News & World Report‘s Best Nursing Homes offers overall ratings, cost, and government inspection reports.
- ProPublica offers a Nursing Home Inspection tool that compiles inspection reports, deficiencies, and fines.
- Caring.com offers reviews, cost information, amenities, and pictures. You can also schedule some tours through the site.
- Glassdoor.com compiles employee reviews. It can give you insight into staff satisfaction, which can significantly impact the quality of care.
Nursing Home Red Flags
We rightfully expect nursing homes to be places of care, dignity, and safety. They are where some of the most vulnerable people seek comfort, support, and respect. Part of choosing a good nursing home is determining when they don’t meet those standards.
Red flags to look for include:
- High staff turnover can disrupt continuity of care and indicate underlying management issues
- Lack of knowledge among staff about safety and care procedures, nursing home policies, and other critical matters
- Unsanitary living conditions with dirty or unsafe environments, such as soiled bedding or unpleasant odors, inadequate housekeeping, poor lighting, and lack of privacy
- Poor personal hygiene in residents who appear unkempt or lacking basic hygiene can signal nursing home neglect
- A history of fines due to failure to meet state and federal regulations
- A designation as a Special Focus Facility by the Centers for Medicare & Medicaid Services is for nursing homes with ongoing, serious issues that could lead to loss of licensing and funding
Questions To Ask a Nursing Home
If you cannot visit a nursing home to ask questions, do so through phone calls or email. Selecting a nursing home is like choosing any other place to live, with the additional burden of knowing that safety and comfort often depend on others, so it’s important to be diligent in your research.
Standards of Care Questions
Safety and health are critical components of choosing the right nursing home. If you are not satisfied with an answer, get clarification on questions, including:
- Are staff members trained in dementia care, fall prevention, and emergency response?
- Is a registered nurse (RN) always available on-site, and how many RNs are there per patient?
- Has the facility had any violations or complaints in the past few years? What were they?
- How do you comply with proper nutrition and hydration standards?
- What physical therapy options do you offer, and can residents get care in their rooms if they cannot leave?
- How do you handle medical emergencies, and which hospitals do you work with?
- What is your fall prevention protocol?
- How do you prevent and handle infections, including flu outbreaks?
- What specialized services do you provide?
- How many caregivers do you have per resident during the day and night shifts?
- What security measures do you have to prevent wandering or unauthorized visitors?
- What are your specific measures to protect against theft of personal items or someone taking financial advantage of residents?
Quality of Life Questions
People moving into nursing homes deserve to feel comfortable where they live. Happiness can also lead to health benefits, so find the right nursing home by asking questions such as:
- Are pets allowed to live in or visit, or is there a facility pet for companionship?
- How do you help with new residents’ adjustment?
- What activities and programs do you offer, and are they tailored to residents’ interests?
- Do the residents seem happy and engaged in their daily activities? (Speak directly with residents if possible.)
- What is the response time when a resident seeks help from their room?
- How do you facilitate an understanding—and preferably bonds—between people in shared rooms?
- Do residents have access to outdoor spaces? Are there staff to assist residents who may have difficulty safely getting there?
- Does the facility accept deliveries on behalf of patients and take packages to their rooms?
Compare the answers you get from staff and residents to the information you found when researching nursing homes. For example, if you ask about violations and complaints and do not get an honest answer, delete that home from your list.
Ultimately, the Right Nursing Home Is a Personal Choice
It isn’t easy to know how to choose the right nursing home. What is right for one person isn’t necessarily right for another. Avoid nursing homes with red flags while considering the totality of reviews, inspections, visits, and other information to identify the right fit.
Pay particular attention to the answers to your questions. They often reveal hidden problems or demonstrate that the staff isn’t being upfront with you.
Choose the right balance for yourself or your loved one. Something that makes a resident happy, such as a beautiful outdoor garden, can make other issues seem less important. Just be sure not to compromise on standards of care and safety.