There are different reasons a person might need nursing home care, from short-term care following a surgery or hospital stay, to long-term permanent care when caring for oneself or a loved one is no longer possible due to physical or mental conditions.
Whether you’re planning ahead or you need to make an unexpected decision, this article will provide advice for choosing the right nursing home.
What Is A Nursing Home?
A nursing home, also known as a skilled nursing facility, provides a range of personal care and health services for people who don’t need to be in a hospital, yet can’t be cared for at home. Nursing homes aren’t just for older adults, but for anyone who requires round-the-clock care.
A nursing home may offer custodial care, medical care, or both.
Custodial care includes help with bathing or dressing, as well as 24-hour supervision, three meals per day, and assistance with other everyday activities. Skilled care involves medical services in the form of nursing care.
Long-term care includes both types of services and is for people who are unable to perform the basic activities of daily living while requiring regular medical care.
No two nursing homes are exactly alike.
Some nursing homes are set up like hospitals, perhaps with nursing stations on every floor, and provide medical services plus rehabilitation, speech and occupational therapy.
Other nursing homes strive to be more like a traditional, neighborhood residence and may not have a fixed day-to-day schedule. They may also let couples live together.
Still other nursing homes will specialize in certain types of care, such as for those with serious memory problems like Alzheimer’s disease, or have a unit within the facility that specializes in such treatment.
If you or a loved one needs short-term care following a surgery or hospital stay, your social worker and/or the hospital staff will often help you find a nursing home that will provide the type of care best suited to your situation, but you can still consider the steps below in making your choice.
Consider What Types of Services You Want
What is important to you?
Some people prefer a facility with a religious connection, so it would be best to speak to religious groups or those at your place of worship about specific facilities.
Others may want physical therapy available to help heal from a recent or chronic injury so that they can continue to get around with as much freedom as possible.
You may also want to consider whether you’d like a facility that provides hospice care.
And, of course, you likely want to choose a facility in proximity to family and friends so that they can easily visit and make sure you’re receiving the best-quality care.
Step 1: Find A Nursing Home In Your Area
Listings for nursing homes in your area can be found at this site from Medicare, but it also serves another function. Nursing homes that receive government money are required to adhere to strict guidelines and are subject to regular inspections.
As a result of these inspections, nursing homes are assigned a grade of between one and five stars, with five stars being the best. This site will also provide you with copies of recent inspection documents.
But don’t stop there. Nursing Home Inspect, a project of the not-for-profit ProPublica investigative news organization, provides even more detail and unredacted inspection reports, plus further context to help put the Medicare rankings into perspective.
Lastly, ask people whom you trust, such as family, friends and neighbors, as well as local community and senior centers for their recommendations.
Consult with your doctor(s) to see if they provide care at any local nursing homes; you may be able to stay under their care after you move in.
Once you’ve narrowed down your list, get in touch with each facility and ask how many people currently live there, the costs, and if there are any waiting lists. Then set up a time to visit each viable option.
 In response to the outbreak of COVID-19, the site has updated information regarding the spread of infection in facilities across the country, and all U.S. nursing homes are required to report infection data. Also, check here for a consumer fact sheet published by The National Voice for Quality Long-Term Care, a non-profit group, on issues surrounding long-term care in the wake of the COVID-19 pandemic.
Step 2: The Visit
Set up a meeting with both the director and the nursing director of each home you’re considering. Most people will have many questions to ask, so it makes sense to write them down ahead of time. If you are unable to visit the facility yourself, have someone you trust visit for you.
Medicare provides a free, printable checklist of things that you should look for and take into consideration during your visit, such as whether the facility is certified by both Medicare and Medicaid, whether it has handicap access, whether the residents appear well cared for, and the way in which staff interact with residents.
These last two are very important.
Do the residents appear well-groomed and in good spirits? Do staff members knock before entering a resident’s room? The checklist is comprehensive and should be filled out for every facility you visit.
Also consider asking how long the director and heads of nursing, food and social service departments have been working there.
If such key members of the staff change often, that may be a red flag that things aren’t going so well at this facility.
Lastly, don’t be afraid to ask any questions you have. If you smell something strange, ask about it. If you see something that you don’t like or don’t understand, ask.
Don’t be tempted to choose a nursing home based on the fancy décor (this is known as the “chandelier effect”) or because the price for care is higher than other nearby facilities.
A higher price tag does not necessarily mean better care, and facilities have been known to pad their patient bills with extra costs, such as $20 boxes of facial tissues, or a charge for each time a staff member opens or closes the blinds in a patient’s room.
After the initial visit, plan to visit the facility again, but this time unannounced. Choose a different day of the week from your initial visit so that you can see different staff in action and view different activities.
Stop in at mealtime to see if the dining room is attractive and sanitary, and whether the food looks appetizing.
Take a look at any areas you didn’t get to see on your first visit. If you have permission, speak with residents about the home, focusing on the things they like and the things they’d like to see improved.
Remember to always respect all residents’ privacy and knock before entering their rooms.
Step 3: Make Your Choice Carefully
Speak with family and friends, doctors, clergy and/or social workers who are familiar with you and understand your personal and health care needs.
If you are the one helping someone make such a choice, involve them as much as possible in the decision-making process as this will ease their transition to the new residence.
If the person you’re helping isn’t able to communicate well, do your best to keep their preferences and values in mind.
Contact Your State’s Long-Term Care Ombudsman
These people are important advocates for those in long-term care facilities and work to resolve resident complaints about their care. They’re required to regularly visit nursing homes and speak with residents about their care.
This makes them ideal people to consult when choosing a nursing home, as they will have answers about the number of complaints they’ve received at a specific facility, the nature of the complaints, and if the issues have been resolved.
Your state’s ombudsman can usually be located through each state’s department of aging, or you can check the directory here.
Determine how you will pay for your care. Medicare generally only covers a small portion of long-term care costs. Everyone’s situation is going to be different, but an excellent resource on ways to pay for nursing home care from the National Institute on Aging can be found here.
Once you’ve selected a nursing home, read the contract carefully or have someone you trust help you understand it before you sign. Again, don’t be afraid to ask questions about the contract with the facility’s director or assistant director.
The decision to enter a nursing home or transition a loved one to supervised care can be a difficult one. Utilize all of the resources set out above, be aware of your options and make a considered choice.
Once moved in, remember that you have rights as a resident, including the rights to:
- Be free from discrimination
- Be free from abuse and neglect
- Exercise your rights as a U.S. citizen
- Have your representative notified about your care
- Receive proper medical care
- Be treated with respect
- Be free from restraints
- Have protections against involuntary transfer or discharge
- Participate in activities
- Spend time with visitors
- Form or participate in resident groups
- Manage your money
- Get information on services and fees
- Have proper privacy, property and living arrangements
- Make complaints
You can find out more about your rights as a nursing home resident here.