Nursing homes (skilled nursing facilities) provide 24-hour medical care, supervision, and assistance for people who need a higher level of care than assisted living can provide. Residents typically require help with most activities of daily living and need regular skilled nursing care, physical therapy, or medical monitoring.
49 steps across 8 sections
1. Determine Care Needs
- Document all medical conditions, medications, and treatments required
- Identify needed therapies: physical, occupational, speech
- Assess cognitive function and behavioral considerations
- Note dietary requirements and any feeding assistance needed
- Determine if short-term rehabilitation or long-term care is needed
- Consult with the current physician about recommended care level
2. Research Facilities in Your Area
- Use Medicare's Care Compare tool (medicare.gov/care-compare) to find and compare nursing homes
- Contact your local Area Agency on Aging (Eldercare Locator: 1-800-677-1116)
- Ask hospital discharge planners, social workers, and physicians for recommendations
- Talk to friends, family, and support groups who have placed loved ones
- Check your state's Department of Health website for inspection reports
3. Compare Quality Ratings
- Review Medicare's 5-star rating system on Care Compare:
- Overall rating Summary of quality metrics
- Health inspections Based on state surveys (most important indicator)
- Staffing Hours of care per resident per day
- Quality measures Clinical outcomes (falls, infections, pressure ulcers)
- Review detailed inspection reports for specific citations
- Check staffing data — this is the single most important quality indicator
4. Visit Facilities in Person
- Tour at least 3-5 nursing homes
- Schedule an initial tour, then make 1-2 unannounced visits
- Visit at different times: mealtimes, activity periods, evenings, weekends
- Ask to meet the administrator, director of nursing, and social worker
- Observe staff-to-resident interactions carefully
5. Evaluate Key Quality Indicators
- Staffing Ask about nurse-to-patient ratios and CNA-to-patient ratios
- Cleanliness Check for odors, spills, and general maintenance
- Call light response Observe how quickly staff respond to resident requests
- Resident appearance Are residents clean, groomed, and appropriately dressed?
- Food quality Ask to sample a meal; check menu variety and special diet options
- Activities Review the activity calendar; observe resident engagement
- Safety Check for handrails, proper lighting, emergency procedures
6. Ask Critical Questions
- What is the staff turnover rate? (High turnover is a red flag)
- How are resident complaints handled?
- What is the discharge policy if care needs change?
- How are families informed of changes in condition?
- What happens if a resident runs out of private funds?
- Does the facility accept Medicaid? (Critical for long-term stays)
- How is pain managed? What is the policy on restraint use?
7. Review the Admission Agreement
- Read the entire contract carefully before signing
- Understand what is included in the daily rate vs. extra charges
- Check for arbitration clauses (consider whether to opt out)
- Clarify policies on room changes, roommate assignments, and bed holds
- Understand the discharge/transfer policies and appeal rights
- Ask about rate increases and notification requirements
- Consider having an attorney review the agreement
8. Plan the Transition
- Work with the care team to create a comprehensive care plan
- Provide detailed medical history, medication list, and advance directives
- Bring personal items to make the room feel homelike
- Establish a visiting schedule and communication plan with staff
- Attend the initial care plan meeting (usually within 14 days of admission)
Common Mistakes
- Choosing based solely on location or appearance
- Not checking inspection reports
- Relying only on scheduled tours
- Not asking about Medicaid acceptance
- Ignoring staffing levels
Pro Tips
- The staffing measure is the single most important quality indicator — priorit...
- Contact your state's Long-Term Care Ombudsman before selecting a facility — t...
- Check Nursing Home Compare (Care Compare) for the facility's 5-star ratings, ...
- Ask about staff continuity — consistent caregivers (same CNAs for the same re...
- Visit at mealtime and try the food — meal quality is a reliable indicator of ...