Choosing the right nursing home for a loved one is one of the most important decisions a family can make. This guide breaks the process into clear steps so you can evaluate facilities on licensing, inspections, staffing, costs, and the right questions to ask during tours. Use this as a checklist to make the process less overwhelming and more objective.
1. Start with Licensing and Certification
Every nursing home must be licensed by the state to operate. Licensed facilities meet basic safety and care standards. In addition to state licensing, look for federal certification if the facility accepts Medicare or Medicaid. You can verify license status online through your state’s health department website. Make a note of the license number and expiration date, and confirm there are no current restrictions or sanctions.
2. Review Inspection Reports and Complaint Histories
Inspection (survey) reports detail any violations found during official inspections and whether corrective actions were taken. Most states publish survey results online, and the federal CMS Nursing Home Compare website aggregates national data. Pay attention to repeated violations, unresolved complaints, and the severity of any citations. Minor issues can be acceptable, but patterns of serious violations (e.g., neglect, unsafe medication practices) are red flags.
3. Evaluate Staffing and Care Quality
Staffing levels and staff turnover directly affect quality of care. Ask about:
- Registered nurse (RN) coverage: How many RNs are on duty across shifts?
- Staff-to-resident ratios for day, evening, and night shifts.
- Staff turnover in the past year: high turnover may reduce continuity of care.
- Availability of licensed therapists, social workers, and specialists.
Observe staff interacting with residents during a tour. Are they respectful, attentive, and responsive? Do residents look clean, comfortable, and engaged?
4. Understand Costs and Contracts
Ask for a clear, written explanation of fees. Typical charges include room and board, nursing services, therapy, medication administration, and ancillary fees (e.g., activities, transportation). Clarify what’s covered by Medicare or Medicaid and what will be billed privately. Important contract items to review:
- Refund and deposit policies.
- Conditions that justify a rate increase.
- Discharge policies—under what circumstances can a resident be asked to leave?
Have an attorney or an elder-care advisor review the contract before signing.
5. Questions to Ask During a Tour
Bring a checklist and ask direct questions. Useful questions include:
- What is the average length of stay and typical resident mix?
- How do you handle medical emergencies and hospital transfers?
- How are medications managed and who administers them?
- Can residents keep personal physicians or request hospice care?
- What are activities and social programs like? How are they tailored to different abilities?
- What infection control measures are in place?
During the tour, note smells, cleanliness, noise levels, and the condition of resident rooms and common areas. Ask to see a sample daily schedule and menus.
6. Check for Specialized Services
If your loved one has specific needs—dementia care, wound management, or rehabilitative therapy—verify that the facility has experience and certified staff for those services. Ask for outcome data: rehospitalization rates, fall rates, and pressure ulcer incidences are indicators of clinical performance.
7. Involve the Team and Trust Your Instincts
Bring family members, the resident’s physician, or a geriatric care manager to help evaluate options. Compare notes after each visit. Trust your instincts—if something feels off during a tour, keep looking. Conversely, good communication, transparency, and responsiveness from staff are strong positive signs.
8. After You Choose
Make a plan for the first 30 days: schedule a family meeting with staff, set goals for care and routines, and provide familiar items from home to ease transition. Monitor care closely and keep open lines of communication with care staff and management.
Final Tips
Use official resources (state licensing sites, CMS Nursing Home Compare) and local nonprofit organizations or ombudsmen for additional support. Document all communications, keep copies of contracts and care plans, and maintain regular visits or check-ins after placement. A thorough, patient approach will help you find a nursing home that provides safe, respectful, and compassionate care.
If you’d like a printable checklist version of the tour questions and inspection items, leave a comment below and I’ll add one to this post.
This is exactly the kind of practical checklist we needed. The section on licensing and inspection reports helped me find a few red flags when we toured a place last month.
As a geriatrician I appreciate the focus on staffing and outcome data. Families should always ask about rehospitalization and pressure ulcer rates—those are telling metrics.
Does anyone have recommendations for carrying out background checks on staff beyond what’s publicly available? I worry about turnover and want to dig deeper.
Helpful post. We signed a contract last year and later found the refund policy was restrictive. Pro tip: have a lawyer review any long-term care contract before you sign.
Local long-term care ombudsmen can help families review complaints and advocate for residents. Contact your state’s ombudsman program for free assistance.