How to Choose a Nursing Home

Use personal visits and professional evaluations to help choose a quality nursing home facility

Before making a decision about nursing home placement, visit any facilities you are considering. You can learn a great deal about a nursing home by taking time to sit and observe how staff interacts with residents. Also, speak with residents and their family members to get a full understanding of life in the home. Gather information on both quality and payment issues.

It is very important to visit homes a second and third time during the weekend or evenings – times when many nursing homes reduce their staff and services. If at all possible, take the resident to visit potential nursing homes before a decision is made. This visit can give you insight into the resident’s wishes and may ease his or her fears.

 

Here’s what to look for on your visits:

Using your senses — sight, hearing, smell, touch:

  • Do you notice a quick response to call lights?
  • Are there residents calling out? If so, do staff respond quickly and kindly?
  • Do the meals look appetizing? Are residents eating most of their food? Are staff patiently assisting residents who need it?
  • Are there residents in physical restraints (formal or informal devices that hold residents in beds, chairs, and wheelchairs)? Why?
  • Do resident rooms appear to reflect the individuality of their occupants?
  • Are rooms, hallways, and meal tables clean?
  • Is the environment noisy?
  • Is there cheerful, respectful, pleasant, and warm interaction among staff and residents?
  • Does the administrator seem to know the residents and enjoy being with them?
  • Do staff and administration seem comfortable and peaceful with each other?
  • Do residents look clean, well-groomed, well-fed, and free from bruises?
  • Do many residents seem alert? happy? peaceful?
  • Are residents seated comfortably?
  • Is the home free from any unpleasant smells?
  • Are residents engaged in meaningful and pleasant activities by themselves or with others?

 

Things you can ask of staff:

  • Does each shift have enough help to be able to care for residents as they’d like?
  • Do they enjoy their work? Are their ideas and information solicited and valued by supervisors?
  • What activities are residents involved in?
  • Are staff permanently assigned to residents?
  • Are temporary staffing agencies used?
  • How are the nursing assistants involved in the care planning process?
  • How much training is given to staff?
  • How often do residents who need it receive assistance with toileting?
  • If residents are using disposable briefs, how often are they changed? Why are briefs used instead of toileting?
  • What approaches does the facility use to prevent use of physical or chemical restraints?
  • How does the staff assure family and resident participation in care planning meetings?
  • What does the facility do to encourage employee retention and continuity?
  • How long has the current administrator been at the facility?
  • Has the facility undergone any recent changes in ownership or management?
  • Does the facility provide transportation to community activities?
  • What kind of therapy is available to residents?
  • Can you give me an example of how individualized care is given to the residents?
  • Is there a resident and/or a family council? Will the facility give you contact information for the leaders of these councils?
  • What happens if someone has a complaint or problem? Are family/staff conferences available to work out a solution?
  • Are residents involved in roommate selection?
  • Who decides where residents sit for meals?
  • Under what circumstances might a resident be transferred to another room or unit or discharged?
  • Does the facility employ a professionally qualified social worker? (“Professionally-qualified” means with a bachelors or masters degree in social work.)

 

Things you can learn from talking with other residents and their families:

  • Are residents treated with respect and kindness?
  • Are residents helped with meals?
  • Does the facility respect the resident’s wishes about their schedule (bedtime, baths, meals)?
  • Is attention given to residents at night if awake? Is there anything for them to do?
  • Does the resident have the same nursing assistant most days?
  • Is there a family or resident council? If so, is the council led independently by families or residents or is it directed by staff members?
  • Are staff responsive to resident requests? Do they assist the resident with toileting?
  • Are snacks always available to residents? Fresh fruit?
  • Do residents participate in care planning conferences? Are his or her opinions valued?
  • Has the resident had missing possessions?
  • Who handles resident or family member concerns? Is that person responsive?
  • Does the resident get outside for fresh air or activities as much as s/he wants?
  • What is best/worst thing about living in the home?