Selecting the Right Nursing Home
The Initial Search
Before you do a lot of leg work, ask around for recommendations. To get started, you can:
- Ask your doctor, family, friends, neighbors, and clergy what experiences they have with nursing homes.
- Ask a hospital’s discharge planner or social worker for recommendations, especially if you are or were recently in the hospital.
- Contact a social service agency and talk to the case manager about nursing home choices.
- Contact your local Agency on Aging for recommendations.
After you’ve asked around and have some homes that sound promising, go for a visit. Before choosing a nursing home for a loved one, visiting more than once is recommended. For example, one day you could observe afternoon activities. Another day you could visit for dinner and see how the community winds down for the night. Sharing a meal with residents and staff can be an especially valuable way to get insights about the facility.
Quick Tip: Always discuss the needs and desires of the older adult who will be living in a nursing home before making a decision.
While touring a nursing home, you’ll note generalities such as the cleanliness of the rooms and hallways and how kindly or not-so-kindly people interact with one another. You might also find that one facility is more fitting than another in ways that matter to your loved one — for example, it might have gardens, a therapy dog, or bilingual caregivers. Below are several questions to consider as you tour the facility.
Quality of Life
- Is the staff respectful and friendly?
- Is the nursing home clean?
- Do they offer social, recreational, religious, and cultural activities that interest you?
- Can you choose your waking, bed, and bathing time?
- Can you get food and drinks anytime? Is the food good? Ask to try it.
- Can you have visitors anytime?
- Can you have a pet?
- Is transportation provided?
- How much privacy is there?
- Can you decorate your room how you like?
- Is the temperature comfortable?
- Is there good natural lighting?
- Do you have a telephone and TV in the room?
Quality of Care
To be a certified Medicare/Medicaid provider, a nursing home must meet 150 requirements ranging from safe storage of food to protecting residents from physical and mental abuse. The State Survey Agency performs an inspection to rate the nursing home on these requirements. Ask to see a copy of this inspection report.
- Will you get a copy of your care plan? Your care plan is based on your health information and must be assessed in the first 14 days and at least every 90 days thereafter.
- Who are your doctors? Can you see your personal doctor?
- What improvement goals is the nursing home working on?
Staffing
Federal law states there must be enough staff to care for the residents. But what is enough? There must be at least one RN for at least eight straight hours, seven days a week. And there must be either an RN or LPN (Licensed Practical Nurse) on duty 24 hours a day.3
- Does the staff wear name tags?
- Does the staff know the residents by name?
- Do they knock on residents’ doors before entering?
- Is there a licensed doctor on staff daily?
Questions to Ask the Nursing Home Director
Here are specific questions to ask directors at nursing homes and similar facilities:
- How many residents live at the nursing home? If the population is large, are residents separated into smaller communities?
- What is the ratio of caregivers to residents? Are particular caregivers assigned to particular residents?
- What is the staff turnover rate? If worker satisfaction is low, it can shape the residents’ quality of life.
- Does the facility provide three balanced meals daily? Do residents have choices at each meal?
- Can residents personalize their rooms with art and other belongings? What furniture is provided?
- When can residents spend time outdoors? Is the nursing home near other things that I like to do?
- What safety precautions are in place for residents with Alzheimer’s disease or other types of dementia? Nursing homes might have secure perimeters, for example, or require certain patients to wear electronic bracelets.
- Does the nursing home provide transportation for medical appointments and help residents with errands?
- What social activities are sponsored by the home? Can residents choose from more than one activity calendar? Generally, the larger the nursing home community, the more diverse the offerings.
- What special services are available? Examples are tailored memory care, sensory therapy rooms, and hairdressing.
- What sources of payment are accepted? Some facilities limit their numbers of Medicare and Medicaid patients because they’re permitted to charge more when billing privately.
- What are the move-out criteria? When might a senior be asked to leave against his or her will? Knowing the answer to this question is especially important if dementia becomes an issue, as some dementia patients tend to disrupt community life.
