How to Choose the Best Nursing Home for Yourself or a Loved One

How to Choose the Best Nursing Home for Yourself or a Loved One
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Medically Reviewed By:
Mark Arredondo, M.D.

If you're looking for a nursing home for yourself or a loved one, it can be easy to get overwhelmed by all the options and information. Here, we break down everything you need to know about nursing homes so you can make an informed decision, including: 

  • What is a nursing home?

  • Things nursing homes are and are not allowed to do

  • The difference between assisted living and a nursing home

  • How to choose a nursing home

What is a nursing home?

About 33% of older adults in the United States will live in a nursing home at some point in their lives, the American Geriatrics Society (AGS) reports. Nursing homes provide a wide range of services for people of all ages who need more care than they can get at home. Such services may include around-the-clock nursing care, meals and assistance with everyday activities, such as dressing, bathing and taking medication as directed. 

Nursing home residents can stay for a short time after an accident or hospitalization to get their strength back, or they can stay permanently due to ongoing mental or physical challenges, according to the National Institute on Aging (NIA).

Assisted living vs. nursing home: What's the difference?

Assisted living is for people who need some help with daily care. It is largely a residential community. By contrast, a nursing home provides a greater level of medical care and support for its residents, the NIA says.

Starting your search for a nursing home

If you are looking for a nursing home for yourself or a loved one, start by asking friends, family, social workers and religious groups for suggestions. You can also ask your healthcare provider for recommendations. Make a list of geographically desirable nursing homes and schedule tours. 

Tours are the best way to see up close what goes on in a nursing home and if you could see yourself or a loved one there. You’ll see more on this below, including things to look for during your visit.

What do you do in a nursing home?

Nursing homes provide a range of care and services for residents. Their offerings may include:

  • Social activities (Think concerts, lectures, art classes and field trips)

  • Exercise programs, such as chair yoga or other exercise classes

  • Religious services

  • Book clubs or discussion groups

  • Skilled nursing care

  • Nutritious meals and nutritional counseling

  • Social work services

  • Physical therapy to help improve strength, mobility and overall fitness

  • Occupational therapy to support activities of daily living

  • Speech or swallowing therapy

  • Breathing treatments for respiratory diseases

  • Wound care

  • End-of-life or hospice care

Not every nursing home provides all of these services. It is important to ask about any services that are important for you or your loved one during your tour. Make sure whatever nursing home you choose ticks the boxes that are most important to you.

Things nursing homes are allowed to do

According to the National Ombudsman Resource Center (NORC) and the 1987 Nursing Home Reform Law, nursing homes must: 

  • Treat all residents with dignity and respect.

  • Allow residents to create their own schedules.

  • Provide residents with information in a language that they comprehend. 

  • Allow residents to complain.

  • Inform residents of any changes in their health status.

  • Allow residents to review their medical records.

  • Allow residents to remain in the nursing facility unless a transfer or discharge is necessary.

Things nursing homes are NOT allowed to do 

The NORC also points out the things that nursing homes are not allowed to do, including:

  • Refusing care

  • Restraining residents

  • Providing inadequate care

Questions to ask when visiting a nursing home

Visiting a nursing home can give you an overall sense of the facility and the quality of care that it provides for residents. 

Make sure to meet with the nursing home administrator and nursing director during your visit.

When touring, look around and ask yourself:

  • Is the nursing home clean?

  • Do the residents look healthy?

  • Are the rooms big enough?

  • Is there enough privacy if residents must share rooms?

  • What recreational spaces are available?

  • Are there railings and grab bars in bathrooms, bedrooms and common areas to help prevent falls?

  • Is the facility handicap accessible?

  • Is the dining room attractive and clean? 

  • Does the food look tempting?

  • What is the security like for the building? 

Make sure to ask these questions of the staff member who is giving you a tour:

  • Is there a special unit for older adults with dementia or memory problems?

  • What is the food like? (Ask to see a sample weekly menu.)

  • Does the nursing home accommodate special dietary needs? 

  • Is transportation provided to community activities? 

  • Who are the doctors that care for the residents? 

  • Can residents still see their personal doctors? 

  • When are visiting hours?

  • Are there ever any restrictions on visits?

  • Can a resident decorate their room with personal belongings or furniture? 

  • How secure are personal belongings?

Other important considerations when choosing a nursing home include proximity to family members and/or the nearest hospital.

There may be times when you or your loved one will need to go to a hospital from the nursing home or the hospital back to the nursing home. Ask how such transfers are handled at the facility.

Licensing and certification

The federal government is in charge of setting standards for nursing homes for people who have Medicare or Medicaid coverage, and state licensure of nursing homes typically follow the same standards set by the federal government, according to the AGS. Make sure to ask if the nursing home is licensed by the state and certified by Medicare and/or Medicaid. The Centers for Medicare and Medicaid Services mandates each state to inspect any nursing home that gets funding from the government. 

If a nursing home fails this inspection, it will not be certified. This is a big red flag.

Always ask to review current inspection reports and certification of any nursing home you are seriously considering.

Other questions related to licensing and certification of nursing homes include:

  • How many nurses and nursing assistants are there compared to residents? There is no one-size-fits-all magic number for the best nursing home staffing level. In general, nursing homes with residents that have more health problems should have more nursing staff than a nursing home where the residents need less health care, according to Medicare.

  • Do the administrators and medical professionals have specialized training? Make sure to ask for details on their training levels.

  • Are staff full-time or part-time?

  • How long have key staff members worked at the nursing home? Nursing homes that have high staff turnover rates should raise a red flag.

  • Is vaccination against the flu and COVID-19 required for all staff members? (If the answer is no, ask what percentage of staff members get these vaccines.)

More tools for choosing a nursing home

  • Use this checklist from Medicare.gov to make sure you are asking all the right questions when choosing a nursing home.

  • Look up any nursing homes that you are considering on the Medicare.gov search tool. This tool shows you how Medicare- and Medicaid-certified nursing homes fare when it comes to health and fire safety inspections, staffing, quality of care and any penalties.

Does Medicare pay for a nursing home?

The majority of people who enter nursing homes pay out-of-pocket for care, at least initially, the NIA says. Medicare may pay for part of the cost for stays of 100 days or less after three days in a hospital, but it generally doesn't pay for long-term care stays. That said, Medicare may cover your health care and prescription drugs while you're in a nursing home. Medicaid may cover long-term nursing home stays.

If you have a Medicare Advantage Plan or other Medicare health plan, ask about nursing home coverage before you make any arrangements.

It's important to ask about costs upfront. 

Questions to ask may include:

  • How much do basic services cost?

  • What services are included in these basic service costs?

  • What additional services are available? 

  • How much do additional services cost?

  • What happens if a resident runs out of money? 

Asking the right questions, meeting with staff and going on tours are the best ways to get a sense of the nursing homes you're looking at so you can make an informed decision for yourself or a loved one.


References

American Geriatrics Society (AGS): Nursing Homes.

National Institute on Aging (NIA): Residential Facilities, Assisted Living, and Nursing Homes.

National Ombudsman Resource Center: Residents' Rights.

Medicare.gov: Staffing for nursing homes.

Medicare.gov: Questions to Ask When You Visit a Nursing Home

Medicare.gov: Find nursing homes including rehab services near me.

Centers for Medicare & Medicaid Services: Your Rights and Protections as a Nursing Home Resident.

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