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Thursday, January 4, 2018

Choosing a Nursing Home

How to choose a nursing home

Finding the right nursing home can be an emotional decision at a time when careful evaluation is required. Here are the tools to help you make the right choice.

Placing a loved one in a nursing home can be a gut-wrenching choice, no matter the cause. With more than 15,600 facilities in the U.S., picking the right nursing home is often a daunting task. But there are several resources which can make the decision easier. Here, we give our top tools, along with a few considerations of our own.

Before You Visit

Nursing homes go by many names: skilled care facilities, nursing facilities, and nursing/rehab facilities. Nursing homes generally provide a higher level of care than assisted living facilities, which are also known as assisted living communities, adult family homes, and board and care homes. All Medicare/Medicaid certified nursing homes undergo unannounced on-site inspections by state health professionals such as registered nurses and licensed social workers. They assess compliance with federal standards of care.

The information can be used in a couple of ways. First, you can eliminate facilities with more severe violations, staffing shortages, and/or patient care problems. Second, make a copy of the report for facilities that you want to consider. Bring it to your first visit to the nursing home and ask questions about issues that concern you, such as: What changes were made to come into compliance? Why is this a recurring problem? Why did it take so long to correct this problem?

It’s easy to obtain inspection results from nursing homes in your area. Below, we’ve highlighted two ways to get information: an inspector tool and a government analysis. Both are simple to use and provide results that are easy to compare.

Nursing Home Inspector Tool

To easily search inspection violations, use the Care Pathways Nursing Home Inspector tool. Start by entering a state, then refine your search by area code, zip code, county, or facility. You’ll get a list of facilities, and you can check out each nursing home’s most recent assessments.

The assessments are arranged by date, with the latest one first. Each covers three topics: the facility itself, staffing levels, and the condition of residents. Issues that earned a deficient rating are listed, along with the scope, harm, and severity of the issue, and what date the problem was corrected. Staffing levels and patient condition are compared to averages in that county and state.

Star Rating System for Nursing Homes

Comparative information is also available from the Centers for Medicare and Medicaid Services (CMS). Their Five-Star Quality Rating System assigns each nursing home an overall star rating of one (low) to five (high) that denotes overall quality. There is also a separate star rating for the facility based on health inspections, staffing, and quality measures.

The health inspection rating takes into account the last three years of onsite inspections, with more weight given to the most recent year. Staffing stars are based on hours of care per resident, with additional consideration for the level of care in that facility based on the severity of need. Residents with higher needs would be expected to get more hours of care. Quality of care measures how well nursing homes are addressing the physical and clinical needs of their residents, and includes the prevalence of antipsychotic medications.

Website Tour

Before you visit, take a virtual tour of the nursing home. Is the setting more institutional or homelike? Are rooms private or will your loved one have a roommate? Is it part of a continuing care retirement community? Is there anything on the site that raises a question you want to ask on your visit?

Long-Term Care Ombudsman

A CNN investigation found one drug company making hundreds of millions of dollars a year by targeting frail and elderly care facility residents for whom the drug appears unnecessary or unsafe.

Every state is required to have an Ombudsman Program to address complaints and push for improvements in the long-term care system. Click here to find an ombudsman in your state.

The Long-Term Care Ombudsman program is overseen by the Administration on Aging, and provides advocates for adult care facility residents to resolve problems and bring about change to improve residents’ quality of life.

Ombudsmen visit nursing homes and speak with residents to make sure their rights are being protected. They are trained to resolve issues you may have, including financial concerns. They can discuss general information with you about nursing homes, resident’s rights, and care. Finally, ombudsmen can answer your questions about the number of complaints a specific nursing home has received, what those complaints were about, and whether the issues were resolved quickly.

Touring and Evaluating Facilities

Once you’ve narrowed your list to a few candidates, it’s time to set up an initial tour with each of them. You’ll get a lot of information about each facility. It’s a good idea to use a checklist at each nursing home to make sure you don’t forget to ask a question. Having a completed checklist also helps you make comparisons later on.

A checklist will remind you to look at how clean the bathroom is and if grab bars are present. It will remind you to note how friendly staff are both to you, and when they interact with patients. You’ll remember to check if there is a window in every bedroom, and how residents call for help in the event of an emergency.

Several nursing home checklists are available online. Here are three of our favorites, in no particular order:

Other Considerations

Ideally, you’ll have time for a visit following the first tour. Drop by unannounced so that you can see how everything looks when visitors are not expected. If you can, make the surprise visit in the evening when staffing levels may be lower.

Choosing a nursing home is a personal decision, and many considerations go into your final decision. You may decide that the home with the best physical therapy arrangement is better for your loved one than another with gourmet food. A facility with specialty care for dementia may beat out another that has a garden. A nursing home that offers a doctor who makes “house” calls might serve your needs better than another with free transportation.

Don’t underestimate the importance of convenience. How many times will you visit your loved one at the facility in town, versus the fancier place 20 minutes away? If you work, it may be preferable to find a nursing home near your office so it’s easy to stop by on your way home. Seeing your loved ones often may be the most important piece to make both of you comfortable with your decision.

Finally, if you have a complaint about a nursing home, try working with management to get it resolved. They may be unaware of the problem. If you still feel the matter needs attention, you can contact a long-term care ombudsman (see sidebar) or your State Survey Agency. Click here for a directory. The State Survey Agency not only conducts inspections but they also investigate and validate complaints.


Compendium of Residential Care and Assisted Living Regulations and Policy: 2015 Edition,” Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services.

Long-term Care Ombudsman Program: What You Must Know,” National Center on Elder Abuse.

Medicare and Medicaid Programs; Reform of Requirements for Long Term Care Facilities ,” Centers for Medicare & Medicaid Services (CMS), HHS.

Revised Federal Nursing Home Regulations,” National Consumer Voice for Quality Long-Term Care.

Five-Star Quality Rating System,” U.S. Centers for Medicare & Medicaid Services.

When It's Time to Leave Home,” National Institutes of Health.

Your Guide to Choosing a Nursing Home or Other Long‑Term Services & Supports,” Centers for Medicare & Medicaid Services.

Nursing Homes,” Care Pathways.

Long-Term Care Providers and Services Users in the United States: Data From the National Study of Long-Term Care Providers, 2013–2014,” National Center for Health Statistics.

Nursing Home Care,” Centers for Disease Control, National Center for Health Statistics.

Blog posting provided by Society of Certified Senior Advisors