Choosing a nursing home for yourself or a loved one is one of the most important and emotionally challenging decisions a family can face. The right nursing home can make a significant difference in quality of life, safety, and overall wellbeing. Knowing what to look for and what questions to ask can help families make a more informed decision during a stressful time.
When a nursing home is the right choice
A nursing home — also called a skilled nursing facility — is typically the right choice when a person requires around the clock medical supervision and personal care assistance that cannot be provided at home or in an assisted living facility. Common reasons for nursing home placement include:
- Recovery from a serious illness, surgery, or injury requiring skilled nursing care
- Advanced dementia or Alzheimer’s disease requiring specialized memory care
- Serious chronic medical conditions requiring ongoing medical monitoring
- Physical limitations that make it impossible to safely live independently or in a less supervised setting
- Caregiver burnout when family members are no longer able to provide the level of care needed
Start with Medicare’s Nursing Home Compare tool
The best starting point for researching nursing homes is Medicare’s Care Compare tool at medicare.gov. This free resource provides detailed information on every Medicare and Medicaid certified nursing home in the country including:
- Overall star ratings on a scale of one to five stars
- Health inspection ratings based on state inspection results
- Staffing ratings including nurse to resident ratios
- Quality measure ratings based on clinical outcomes
- Detailed inspection reports including any deficiencies cited
- Ownership information and whether the facility has been subject to enforcement actions
Start by searching for nursing homes in your area and comparing their ratings. Facilities with four or five star overall ratings and strong staffing scores are generally a good starting point for further evaluation.
Factors to consider when evaluating nursing homes
Beyond star ratings there are many important factors to consider when evaluating a nursing home:
- Location — proximity to family members who will visit regularly is important for the resident’s emotional wellbeing and for family members’ ability to monitor care quality
- Staffing levels — adequate staffing is one of the most important indicators of care quality. Ask about nurse to resident ratios on all shifts including nights and weekends.
- Staff turnover — high staff turnover can be a sign of poor management or working conditions and can negatively affect the consistency and quality of care
- Specialized care — if the resident has specific needs such as dementia care, wound care, or rehabilitation services make sure the facility has the staff and programs to meet those needs
- Cleanliness and odor — a well run facility should be clean and free of unpleasant odors. Pay attention to common areas, resident rooms, and bathrooms during your visit.
- Atmosphere and culture — observe how staff interact with residents. Are they respectful, patient, and attentive? Do residents appear engaged and comfortable?
- Activities and programming — a good nursing home offers a variety of activities and social programming that promotes mental and physical engagement
- Food quality — meals are an important part of daily life in a nursing home. Ask to see a menu and if possible taste a meal during your visit.
- Resident and family satisfaction — ask the facility for information about resident and family satisfaction surveys. Talk to residents and family members during your visit to get their candid impressions.
Visiting nursing homes
Before making a decision visit any nursing home you are seriously considering in person. Tips for getting the most out of your visit:
- Visit at different times of day including during meal times and in the evening when staffing levels may be lower
- Ask for a tour of the entire facility including resident rooms, common areas, dining areas, and outdoor spaces
- Observe how staff interact with residents — are they attentive, respectful, and kind?
- Talk to residents and family members who are visiting — their candid feedback can be invaluable
- Pay attention to smells, cleanliness, and the overall atmosphere
- Ask to speak with the director of nursing and the social worker
Questions to ask during your visit
When visiting a nursing home consider asking the following questions:
- What is the nurse to resident ratio on each shift?
- What is the staff turnover rate?
- How are medical emergencies handled?
- What is the process for communicating with family members about changes in a resident’s condition?
- What activities and social programming are offered?
- How are resident concerns and complaints handled?
- What is the process for addressing grievances?
- Does the facility accept Medicare and Medicaid?
- What are the costs and what is included in the base rate versus charged separately?
- What is the policy on personal belongings and room personalization?
Understanding nursing home costs
Nursing home costs vary significantly by location and the level of care required. The national median cost for a private room in a nursing home is approximately $9,000 to $10,000 per month. A semi-private room typically costs somewhat less.
It is important to understand exactly what is included in the base monthly rate and what is charged separately. Common additional charges include:
- Personal care supplies such as incontinence products
- Physical, occupational, and speech therapy
- Specialized medical equipment
- Transportation to medical appointments
- Beauty and barber services
- Cable television and telephone
How nursing homes are paid for
Nursing home care can be paid for through several sources:
- Medicare — covers short term skilled nursing facility care following a qualifying hospital stay for up to 100 days under specific conditions. It does not cover long term custodial care.
- Medicaid — the primary payer for long term nursing home care for people who meet financial eligibility requirements
- Long term care insurance — policies that cover nursing home care up to the policy limits
- Private pay — personal savings, retirement accounts, and other personal funds
- Veterans benefits — eligible veterans may qualify for VA benefits that help cover nursing home costs
The role of the long term care ombudsman
Every state has a long term care ombudsman program that advocates for the rights and wellbeing of nursing home residents. Ombudsmen investigate complaints, help resolve problems, and provide information about nursing home quality. If you have concerns about a nursing home you are considering or one where a loved one already resides contact your state’s long term care ombudsman program.
You can find your state’s ombudsman program through the Administration for Community Living at acl.gov.
After placement — staying involved
Choosing a nursing home is not the end of the process. Staying actively involved in a loved one’s care after placement is one of the most important things a family can do. Regular visits, communication with staff, and participation in care planning meetings help ensure that the resident’s needs are being met and that any concerns are addressed promptly.
Key terms to know
- Skilled nursing facility — a licensed facility providing 24 hour medical care and personal care assistance
- Care Compare — Medicare’s online tool for researching and comparing nursing homes at medicare.gov
- Star rating — a one to five star rating system used by Medicare to evaluate nursing home quality
- Long term care ombudsman — an advocate for the rights and wellbeing of nursing home residents
- Staffing ratio — the number of staff members relative to the number of residents
- Custodial care — non-medical assistance with daily activities such as bathing, dressing, and eating
Sources
- Medicare.gov — Care Compare
- Administration for Community Living — acl.gov
- Centers for Medicare and Medicaid Services
- National Consumer Voice for Quality Long-Term Care
This article is for general informational purposes only and does not constitute legal or medical advice. Nursing home regulations and costs vary by state. Consult a licensed professional or contact your local Area Agency on Aging for guidance specific to your situation.