How to choose a nursing home: a practical checklist

Most families pick a nursing home in a hurry. Someone is in the hospital, the discharge planner hands over a list, and you have a day or two to decide. This is the order we'd go in if we were doing it ourselves.

Start with what kind of stay it is

A short rehab stay after surgery or a hospital visit is a different decision from a long-term move. For rehab, look closely at the short-stay quality rating and at how many patients go back home. For a long-term stay, staffing and staff turnover matter more, because the same people will be caring for your relative day after day.

If dementia is part of the picture, ask early whether the home has a secured memory care unit and how it handles behaviors without leaning on antipsychotic drugs.

Make a shortlist from the numbers

Location matters more than people expect. A home ten minutes from family usually beats a slightly better-rated one an hour away, because regular visits are one of the best protections a resident has.

Once you have the homes within reach, look past the overall star rating at the three parts behind it: inspections, staffing and quality measures. Our guide to how the star ratings work explains each one.

Then read the inspection citations. Most homes have some. What you're looking for is anything marked G through L, which means a resident was actually harmed or put in serious danger, and the same problem showing up inspection after inspection. Here's how to read them.

A few red flags deserve a direct question to the administrator:

an abuse citation icon
Special Focus Facility status
large fines
an ownership change in the past year
nurse staffing or turnover far worse than the state average

Call before you drive over

Ask whether they have a bed and when, whether they take Medicare, Medicaid and your specific insurance or Medicare Advantage plan, and whether they can handle any special needs such as dialysis, wound care, a feeding tube or a language other than English. It saves a wasted trip.

Visit, and go back at a different time

The scheduled tour shows you the home on its best behavior. If you can, stop by again at dinner or on a weekend, when staffing is often thinner. Watch how long call lights stay on, whether residents are up and dressed, and how staff talk to them when they think nobody is paying attention. We put together 30 questions to bring with you.

Call the ombudsman

Every state has a long-term care ombudsman program, free advocates for nursing home residents. They won't tell you which home to pick, but they know which ones generate complaints. You can reach your local office through the Eldercare Locator at 1-800-677-1116.

Read the admission agreement slowly

Two federal rules are worth knowing before you sign anything at a Medicare- or Medicaid-certified home:

The home generally can't make a family member personally guarantee payment as a condition of admission. Signing as the resident's representative is different from agreeing to pay out of your own pocket, so read that section carefully.
The home can't make an arbitration agreement a condition of admission. If one is in the packet, you're allowed to say no.

Also ask what happens if your relative runs through their savings and switches to Medicaid. Some homes have only a limited number of Medicaid beds. If anything in the contract is unclear, the ombudsman or an elder law attorney can look it over.