Choosing a Nursing Home

Overview

A good first step to choosing a nursing home is to make a list of homes you might be interested in. Talk to family, friends, doctors, and others to get recommendations of good nursing homes.

Visit several nursing homes with your family. Most nursing homes have an admissions coordinator who is able to answer your questions and show you the facility. Discuss what you like and don't like about each facility. It may be helpful to keep written notes about each facility. Don't hesitate to ask for written material from each nursing home you visit. You may want to visit each one more than once.

As you look at the choices before you or your loved one, pay special attention to how each one feels to you. Note the levels of nursing care each provides, the cost of each nursing home, and where it's located.

Answering the following questions can help you make the best possible decision:

Does the nursing home feel right to you or your loved one?

• Is it clean and odor-free? Are there smoke detectors and sprinklers? Are there handrails where you would need them? Are exits clearly marked and unobstructed? Are halls and rooms clear from obstacles? Are floors free from spills? Is the temperature comfortable?
• Do the residents seem clean and comfortable? Is the staff responsive and friendly to them? How long does it take for a resident's call lights to be answered? Do you see staff members helping residents change their positions regularly (for example, turning in bed, or moving from the bed to a chair)? How does the staff handle confused or aggressive residents? What is the nursing home's policy for restraining confused or aggressive residents?
• Are separate rooms available, or do residents share a room? Can you bring your own furnishings? Space should be ample, and the rooms should be free from clutter. Are TVs and phones available in each room? Do residents have their own bathroom, or do they share?
• Do residents with special needs, such as dementia or Alzheimer's disease, live in separate areas?
• Is a pleasant area available outside, such as a yard or garden area? Is there an area for children to play? Are pets and plants allowed?
• Are meals served on time? Are meals attractive? What steps are taken to manage specific dietary needs? If residents can't feed themselves, staff should be right there to help.
• Does the nursing home have a social director who plans events for the residents? Are religious services held? Is a hairdresser or barber available? What laundry services are available?

Can the nursing home provide the kind of care you need?

• Will your doctor be able to direct your or your loved one's care? If not, find out how often the nursing home's medical director personally visits each resident. Will you be able to talk to the medical director if you have questions or concerns? Will the medical director meet with you and your family if needed?
• Does the nursing home provide enough help with daily tasks?
• Is 24-hour nursing care available?
• Are hospice or other specialized services (such as Alzheimer's care) offered? If they're available, is there a waiting list for these services? Call or visit a local hospice program to ask about which nursing homes they most often work with.
• Can you see the state licenses for both the nursing home and the administrator? Both should be licensed in the state where the nursing home is located.
• Can you see a copy of the nursing home's most recent state inspection report? If you don't see it posted, don't hesitate to ask to see a copy.
  • The state inspection report will alert you to any violations the facility has received and the actions taken to correct these violations.
  • In addition to your state's regulation, the Health Care Financing Administration (HCFA) is the branch of the Health and Human Services department of the federal government that oversees Medicare and Medicaid programs. HCFA provides Medicare and Medicaid reimbursement to nursing homes to provide care for the elderly and disabled. HCFA regularly inspects nursing homes to ensure that Medicare and Medicaid guidelines are met. Do not hesitate to ask the facility about its most recent state and federal inspections.

Does the nursing home have adequate, qualified staff?

• Does the nursing home staff have experience caring for people with your or your loved one's unique needs?
• Is the nursing home able to retain qualified staff members? One good way to find out is to ask how much staff turnover there is. Visiting on more than one occasion will allow you to see if the same staff members are there each time.
• What is the education level of the staff?
  • Many nursing homes are staffed primarily with certified nursing assistants (CNAs), who provide the majority of care to residents. Training programs for CNAs vary from state to state. Most training programs are several weeks to months in length. They provide training to care for elderly, homebound, and ill people. A licensed practical nurse (LPN) or registered nurse (RN) should be available at all times to oversee the care given by the CNAs.
• Does the staff get regular educational training?
• Does the nursing home screen potential employees to make sure that it doesn't hire people with a history of abusing others?

How will you pay for it?

• How much does the nursing home cost? Price can change depending on the nursing home and the type of care offered. Talk with family, social workers, or eldercare agencies in your community about your payment options. If you have concerns about how you'll pay for a nursing home, talk to representatives from Medicare and/or Medicaid.
• Think about your payment options.
  • Many people pay for nursing home services with their own money.
  • Some people have long-term care insurance that helps cover some costs.
  • Medicaid and Medicare offer resources for people who qualify. For more information on nursing home services and Medicare and Medicaid benefits, you can call toll-free (1-800-633-4227) or visit the Medicare website (www.cms.gov).
• Don't cancel your or your loved one's health insurance. You can use it to pay for hospital care, doctor services, or medical supplies in the nursing home.

Is it the right location?

• If family and friends want to visit, think about choosing a nursing home that's close by and easy for them to visit.