When you make the determination that a loved one needs senior care, choosing the right nursing home can be daunting. With many options and questions that need to be answered — often in short order — there’s lots to research when finding the right place to provide the compassionate, high-level care your loved one deserves.
“I always encourage families to dig deeper and find anecdotal, informal information,” says Nancy Avitabile, an aging life care manager and owner of an aging life care practice in New York.
The following tips may help you understand how to choose a good nursing home.
[READ: Nursing Home Requirements: Who’s Eligible?]
Tip 1: Consider the Facility’s Location and Features
The facility and its design can impact the care of your loved one. Here are some specific aspects of the nursing home community to consider when assessing whether it’s a good fit.
Proximity
The closer a facility is to your home, the more likely you’ll be able to visit and talk with staff.
“Don’t compromise on proximity to family and friends,” Avitabile advises.
Grounds
Tour the building and grounds to assess whether it’s clean and tidy or needs maintenance. The condition of the nursing home can provide insight into the level of care the staff may provide to your loved one.
Also, look for any outdoor living space where your loved one might be able to get some fresh air or visit with family or friends.
Room amenities
Don’t settle on a nursing home based only on the look of the building, courtyards, common spaces or rehabilitation units.
“Ask for a glimpse of all the units,” Avitabile suggests. “The subacute rooms — for short-term rehab stays — bring more money to the nursing home and often get renovated. You should see the rooms designated for long-term care.”
Consider whether the rooms feel welcoming or if they look like a sterile hospital space.
Rankings and assessments
The Centers for Medicare & Medicaid Services uses a five-star quality rating system to help families compare options and identify questions they should ask when looking for a nursing home. Nursing homes receive five-star ratings by performing above average while one-star homes are performing below average.
U.S. News & World Report’s Best Nursing Homes ratings can also help you find the best nursing homes in your area.
Each state has its own inspection and rating system that assesses safety and quality of care in nursing homes, so be sure to check with local authorities as well.
While no single ranking system or assessment program can capture all the important considerations that go into making a decision about which nursing home is best for your loved one, asking about past safety incidents can help you determine whether a particular nursing home is generally safe or risky for residents.
Emergency plans
In long-term care facilities where not all the residents are mobile, it’s important to understand how the care team will look after your loved one if an emergency occurs. Questions to ask about nursing home safety:
— Do you have an emergency evacuation plan?
— Do you hold regular fire drills?
— Do you conduct nightly bed checks?
— How often does the staff check on residents during the day?
— Do you use any high-tech resident monitoring services?
Fall prevention
Falls are a major area of concern for older adults and are an important metric that can help you determine whether a nursing home is taking care of its residents appropriately. You can check with the CMS to learn more about falls at a specific facility.
In addition, you should ask:
— How often do residents fall?
— What do you do when there’s a fall?
— What do you do to prevent falls?
[READ: Nursing Homes vs. Assisted Living.]
Tip 2: Assess Staffing Concerns
Many nursing homes have long struggled to maintain adequate staffing rates. The situation was exacerbated by the COVID-19 pandemic, which led the Biden administration to announce reforms to improve the safety and quality of nursing home care, including mandates for adequate staffing levels and boosting accountability and ensuring greater transparency. These regulatory changes began taking effect in 2024 and will be rolled out over a period of years to improve resident safety in long-term care facilities.
Staff-to-patient ratio
Sufficient staffing is crucial for your loved one’s health. The nursing home should be adequately staffed with professionals, including physicians, registered nurses, family counselors, certified nursing assistants and aides, physical therapists and wound care specialists.
You can ask about the home’s staff-to-patient ratio and whether the nursing staff are comfortable with the patient-to-nurse ratio. If they feel rushed or overwhelmed when caring for residents, that could be a sign of insufficient staffing.
Staff retention and turnover rates
Heavy turnover is an obvious indication of unhappy workers, whose dissatisfaction could mean worse care.
“Some of the best nursing homes I’ve worked with have high staff retention, and sometimes you’ll even see generations of family members who’ve worked there,” Avitabile says. “You want staff who feel they’re doing something meaningful. I like to know the longevity of the management and administrative teams as well. More continuity shows a more stable infrastructure.”
Staff qualifications
Staff must also be adequately trained for the tasks they’re expected to perform. Ask several questions about nursing home staffing, including:
— How are staff trained?
— Are staff expected to engage in continuing education opportunities?
— Are staff members subject to full background checks?
— Do staff members receive specific training to manage older adults with the conditions (e.g., dementia) your loved one has?
[READ Understanding the Different Elder Care Options]
Tip 3: Seek High-Quality Care
It’s important to get a sense of whether the staff at a facility seem to truly care about their patients or if they’re just going through the motions. This may be more difficult to assess, but there are a few simple ways to gauge care quality.
Daily care routines
Nursing homes provide a range of services including helping residents with the activities of daily living (toileting, hygiene, eating and medication management), and offering skilled nursing care to address chronic or acute health conditions.
Nursing homes typically develop individual care plans for each resident in collaboration with the family. Before your loved one moves into a nursing home, ask the staff what their care plans entail, whether specialized care services are offered and how your loved one can access those services if necessary.
Medical assistance
While nursing staff are typically on-site, ask how often a doctor or other medical provider is available and how your loved one can access medical care if and when needed. Other questions to ask:
— What happens if your loved one’s care needs change or if they have an emergency medical situation?
— Does the home offer preventive health care services, such as flu shots, or will your loved one have to visit with their primary care provider for these kinds of services?
— How are residents’ medical records tracked and updated, and does the home communicate with the resident’s primary care provider?
— Are dental and vision services available on-site?
— If your loved one needs care from a provider off-site, who arranges that transportation?
Compassion and respect
In addition to taking a tour and speaking with administrative leaders of a facility, ask to speak with nursing leaders or activity leaders to assess their communication and caring skills.
In their responses, listen for signs and signals of empathy and compassion.
“Ask if they are willing to share if they have family members in nursing facilities and how they made their decisions of placement,” recommends Dr. Frank Flowers, medical director at Kaiser Permanente in Southern California. “Ask them what they enjoy the most about caring for their residents.”
You should also inquire about how consistent their assignments are, as this can help caregivers gain a deeper understanding of residents’ needs and preferences. It also helps residents feel more secure and comfortable.
Tip 4: Consider Quality-of-Life Issues
Good nursing homes offer robust opportunities to forge social connections, enjoy activities, eat well and engage in other amenities that can help support longevity, overall health and well-being.
There are many ways nursing homes can help improve the quality of life for seniors in their care. Ask the following questions:
— Which activities are available? Are there options beyond Bingo and movies?
— Who runs activities, and how are they managed?
— How do these staffers encourage seniors to participate in activities?
— Are there activities suited for different levels of cognitive ability? Physical ability?
— Do residents take excursions outside the home?
Meal plans and nutrition
Many nursing homes cater to varying dietary needs and offer gourmet menu options.
Check out the dining room facilities and ask what sorts of meals and snacks are available. Many homes will let you sample some of the food so you can see what will be offered if your loved one moves in. Questions to ask:
— Can residents eat whenever they want or do they have to stick to specific meal times?
— How does the staff work with seniors who may not be interested in eating to help keep them well nourished?
Meaningful tasks
Some nursing homes give capable residents opportunities to engage in the meaningful tasks they once did at home. For example, some residents may be asked to help deliver mail, bring water pitchers to residents or read to others. These activities may seem small, but they can make a big difference in providing an empowering sense of purpose for some residents.
Decision-making opportunities
Your loved one should have some say in their care, such as sleep and wake times, which activities to choose, what to wear and what to eat. For example, ask if residents eat together during meal times or whether they’re allowed to eat in their room if they prefer eating alone.
Privacy and independence
Are seniors in the home allowed some measure of privacy and independence? Are they treated as adults with respect for their personal boundaries and preferences? Are their dietary, spiritual and other personal boundaries respected and accommodated?
These aspects of a nursing home can be more challenging to observe and assess, but if you look closely at how staff interact with other residents, you may see a philosophy of care that does or doesn’t line up with what your loved one deserves.
Tip 5: Ensure Community and Family Engagement
Most nursing homes actively seek to connect with the wider community and to bring families into the home to interact with loved ones. Each home has its own specific mix of options and policies — from volunteer programs that provide caregiving support and entertainment to liberal family visitation policies — that you should be sure to ask about when looking for the right fit.
Visitation policies
Ask specifically about the home’s visitation policies. Isolation and loneliness are major health concerns for everyone, but they’re especially problematic in seniors in long-term care situations. Look for a nursing home that allows residents to see their loved ones often. Find out if you can drop in whenever you like or if you must schedule in-person visits during certain hours.
You should also ask about other visitation options, such as impromptu or scheduled video calls.
Tip 6: Research Legal and Financial Matters
There are many legal and financial matters that must be considered before enrolling your loved one in a specific nursing home. Chief among these is how to pay for that care.
Cost and payment plans
Many people assume that Medicare will cover the cost of their stay in a nursing home, but that’s not always the case.
“Medicare covers medical costs like physical therapy, doctor visits and hospital admissions — basically, the services that get you well again,” says Stephanie Pogue, a St. Louis-based certified Medicare insurance planner and the CEO of St. Louis Insurance Group in Chesterfield, Missouri.
But Medicare “only covers skilled nursing in a nursing home if a person is getting better or if stopping the care would put the patient in a worse situation,” she adds.
There are additional limitations on top of that.
“Most importantly, it covers a maximum of 100 days,” Pogue explains. “Medicare will pay for the first 20 days of skilled nursing and then there are copays associated with the next 80 days.”
In other words, you or your loved one may be on the hook to cover at least part of their care costs in a nursing home. Be prepared for these fees to add up quickly. Medicare’s skilled nursing benefit is not designed to help with long-term, custodial care that is typically associated with nursing homes and assisted living facilities. Just know that you have other options when Medicare stops paying for nursing home care.
Medicaid is a program that helps low-income seniors. Ask whether the nursing home accepts Medicare or Medicaid and how financial and legal matters related to costs are managed.
Some nursing homes also work with patients and their families to draw up individualized payment plans to help ease the expense of paying for care. Ask what options are available.
Keep Asking Questions After Move-In
Finding a nursing home that checks all the boxes may be challenging, but it’s possible.
For best results, even after you’ve selected a facility, continue to ask questions and stay involved in your family member’s care, especially if you notice any red flags, such as a sudden change in policies, a noticeable shift in your loved one’s cognition or administrators who never seem to be around.
“My most important advice is wherever you choose, keep connected with the facility,” Flowers says. “Even though the connections with staff and administrators may not be in person, your demonstrations of care and concern for your loved one will only help to reinforce and enhance the attention given to your loved one.”
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How to Choose a Nursing Home: Qualities to Look For originally appeared on usnews.com
Update 11/04/24: This story was previously published at an earlier date and has been updated with new information.
