How to Choose the Right Nursing Home
Placing a loved one in a nursing home can bring up strong emotions. You may be concerned about your loved one’s safety and well-being in a nursing home, and rightfully so. Nursing home abuse and neglect are significant public health concerns. A 2024 study by the independent health policy research organization KFF found that 28% of nursing homes had serious deficiencies during health inspections, compared to 17% in 2015. The average number of deficiencies per facility also increased by 40%.
Knowing how to choose a nursing home can provide peace of mind for you and your loved one. This guide offers practical guidance on the key characteristics to evaluate in a nursing home, including what questions to ask and where to find comprehensive information about specific facilities.
Medicare and Medicaid Considerations
The average cost of skilled nursing care nationwide is $305 per day for a semi-private room or $350 for a private room. In higher-cost areas, such as California, nursing homes can cost $450 per day or more. Medicare only covers short-term stays for up to 100 days, and only after a hospitalization of at least three days. Long-term care insurance may provide coverage, but it is often limited. Even if you can afford a private pay option, funds could run out over time.
Once your loved one runs out of funds or insurance coverage, a nursing home could evict them. However, if the facility is certified to accept Medicaid, your loved one can apply for benefits. Even if you have other options now, choosing a Medicaid-certified facility eliminates the risk of payment-related evictions.
Location
When choosing a nursing home, prioritize facilities close to where you live or work. Studies have shown that nursing home residents who receive regular visits from family members have a better quality of life and health outcomes. Residents with dementia experience fewer behavioral incidents. If possible, visit at irregular times, including during overnight hours. Knowing you could show up at any time can motivate staff to provide better care around the clock.
Special Needs
When visiting a facility, ask whether it is equipped to meet your loved one’s special needs. If your loved one has dementia, look for a facility with a specialized memory care unit. It should be locked to prevent wandering and elopement. Ask if the staff have any specialized training. If your loved one needs a ventilator, look for a facility with specialized respiratory therapies or units equipped specifically for long-term ventilator management.
Other special care services to ask about include the following:
- Wound care
- Diabetes management
- Mobility support and bedsore prevention
- Incontinence care
- Mental health care
- Fall prevention
Arranging for Placement During a Hospitalization
If your loved one is entering a nursing home from a hospital, coordinate with the hospital’s discharge planner. Every nursing home has different protocols for accepting patients, and some have waiting lists. The discharge planner should understand the options based on your loved one’s insurance and needs.
Hospitals are legally required to assist patients in finding suitable care after discharge. They cannot charge more if your loved one requires hospitalization for extra days because of inadequate discharge planning.
You and your loved one have the final say in choosing the facility that the discharge planner recommends. The Long-Term Care Ombudsman can advise you of any quality concerns with the facility and answer questions about a facility’s care quality and capabilities.
Seek References
When considering a specific facility, ask people with inside knowledge if they recommend it. The following people may be able to help:
- Friends and relatives
- Local clergy or church groups who visit nursing homes
- Senior advocacy groups
- The Long-Term Care Ombudsman
- Alzheimer’s support groups
- Social workers
- Doctors and nurses
- Current residents
- Former staff
Personal Visits
Visit each facility you are considering and ask staff detailed questions, such as whether they enjoy working there, whether there are enough staff members to meet resident needs, and how long residents wait for responses to call lights. Ask residents how they like living there, how often they receive showers, and how the staff treats them. Ask if they like the food and what activities are available.
Visit the facility at various times, including evenings and weekends, to observe how it operates 24/7. Ask to see the resident rooms, dining areas, restrooms, showers, and the kitchen. If the facility refuses access to some areas, be concerned. Observe the condition of the facility and residents as discussed below.
Facility Cleanliness
Notice how every area of the facility looks and smells.
- Do floors and walls look clean?
- Does the facility smell clean, or do you notice strong offensive odors, such as urine, feces, mold, or body odor?
- Are bathrooms and shower rooms clean and sanitary?
- Is the kitchen clean and sanitary, with food properly stored and dated?
- Do you see handwashing stations, and are staff using them?
- Are clothing and linens clean? Are there any piles of laundry?
Resident Safety and Quality of Care
The condition of the residents and their living conditions speak volumes about the quality of care. Observe the following:
- Are all residents clean and well-groomed?
- Do residents seem happy and active?
- Is there a posted activities schedule?
- Do staff treat residents with respect?
- Is the facility attractive and home-like, or does it feel like a hospital?
- Are residents well-supervised?
- Are hallways and walking areas free of slip, trip, and fall hazards?
- Are residents alert and awake or constantly asleep?
- Are most residents in diapers, or do staff assist them with toileting?
- Do you observe angry outbursts between residents or threats of violence?
Staffing
Short-staffing in nursing homes puts residents at risk of neglect and abuse. If you notice any of the following, the facility may be understaffed:
- Unanswered call lights
- An inability to locate staff
- Residents remain in bed late in the morning
- Unkempt residents
- Residents who say they haven’t showered in days or weeks
- Staff who seem rushed or stressed
- Residents left in wet or soiled diapers or linens
Costs & Contracts
Ask to speak with the facility’s patient financial services or business office to get a breakdown of the costs. If your loved one is a Medicaid beneficiary, a nursing home cannot require payment above what Medicaid pays for covered services.
Request a copy of the contract and the accompanying paperwork before making a final decision. You may be an agent under a power of attorney, giving you authority to sign agreements on your loved one’s behalf and manage their financial affairs. Be on the alert for language that could make you personally responsible for costs if your loved one fails to pay. While the Nursing Home Reform Act prohibits this practice, some nursing homes still sneak it into their contracts.
Arbitration Agreements
Many nursing homes include arbitration agreements in their admissions paperwork. An arbitration agreement requires the parties to submit disputes to an arbitrator chosen by the nursing home. If bound by an arbitration agreement, your loved one generally loses the right to sue the nursing home for medical malpractice, abuse, or neglect.
In 2019, the Centers for Medicare and Medicaid Services issued a final rule prohibiting nursing homes from requiring residents to sign arbitration agreements as a condition of admission or continuing care. However, many nursing homes still pressure residents to sign them. Avoid signing any arbitration agreements.
In California, only a resident or someone with a general or durable power of attorney can sign a nursing home arbitration agreement. An agent under a health care power of attorney cannot sign an arbitration agreement on the resident’s behalf. However, every state is different. Before signing any nursing home contract, consider having a lawyer review it. If a nursing home asks you to sign an arbitration agreement, and you have questions about it, call Lanzone Morgan, LLP and speak to one of our attorneys.
Explore Violations and Reviews
Many online resources can help you investigate a nursing home’s history of violations. Use the resources below to access complaints, inspection reports, and stories from nursing home residents and their families.
Nursing Home Compare
Nursing Home Compare is a free tool from the Centers for Medicare & Medicaid Services that helps families research nursing homes nationwide. It provides star ratings and detailed information on health inspections, staffing, and quality of care. You can view inspection reports from the last 12 months. You can learn a great deal by reading a few inspection reports and identifying recurring deficiencies.
Under staffing and quality measures, you can view each facility’s performance against state and national averages. Unfavorable findings in the following areas are red flags for abuse or neglect:
- Staffing levels
- Hospitalizations
- Antipsychotic medication use
- Bedsores
- Injury-producing falls
- Indwelling catheter use
- Worsened mobility
- Increased dependence on staff
- Excessive weight loss
Yelp & Google Reviews
Yelp provides detailed nursing home reviews, usually written by family members of residents. You can also read reviews by family members through Google. Simply search Google for the facility’s name, followed by the city and state. You will see the reviews to the right of the search results.
Yelp and Google reviews can provide strong insight into the real-life experiences of residents and families. Occasionally, reviewers are competitors or people working for the nursing home. However, Yelp and Google reviews can be an important part of the bigger picture. Look for multiple reviews that mention similar experiences, whether positive or negative.
ProPublica Inspection Site
ProPublica is an independent, nonprofit investigative journalism organization that provides public interest reporting. The organization’s Nursing Home Inspect enables you to quickly view a summary of each nursing home’s deficiencies in one convenient place. ProPublica allows you to access inspection reports dating back multiple years, providing more historical context than Medicare’s tool, which limits access to the last 12 months.
The Consumer Voice
The Consumer Voice is a long-term care advocacy organization that provides up-to-date news and education on topics that matter to nursing home residents and their families, such as the following:
- Resident rights
- Arbitration agreements
- Staffing
- Everyday life in a long-term care facility
- Visitation restrictions
State-Based Resources
Most states provide public access to nursing home health inspection reports and complaint data. The agency responsible for nursing home licensure and enforcement in your state typically provides this information online. Every nursing home in the United States is required to publicly post information about the local ombudsman, who can direct you to the correct agency and its website.
Resources For California Residents
The California Health Facilities Information Database, also known as Cal Health Find, provides access to inspection reports for California nursing homes. You can view health and complaint inspection reports here. It includes reports that did not result in a federal citation, which are excluded from Medicare’s tool. You can also do a quick side-by-side comparison of up to three facilities using this tool.
The Cal Long-Term Care Compare tool provides an easy search tool that allows you to do a side–by-side comparison of up to six nursing homes at a time and view the following details for any Medicare or Medi-Cal-certified facility in California:
- Staffing levels
- Quality ratings
- Health and safety inspection results
- Specialty care offered
The Importance of Choosing the Right Nursing Home
Nursing home residents who receive quality care and dignified treatment enjoy their highest achievable level of health and independence for the longest time possible.
At Lanzone Morgan, LLP, our nursing home abuse attorneys are singularly focused on protecting the rights, dignity, and welfare of the elderly community. We provide a voice to the voiceless, offering advocacy, support, and legal representation when nursing homes fail to deliver the quality care and respect that residents deserve.