What To Consider When Considering A Nursing Home

What To Consider When Considering A Nursing Home

by Kim Keller

Take a deep breath.  The first visit is the hardest.  Here are some of the things we considered, and some of the questions we asked, and more importantly, some of the things we wished we had asked.

The Basics:

  • Where is the nursing home located?  Is it close enough for family and friends to visit regularly?  Is it close enough to your parent’s doctors to make it easy to get to appointments?
  • Make sure the home is certified by both Medicare and Medicaid.  The federal government sets more than 150 different standards of care that a nursing home must meet, and inspections are conducted annually to ensure compliance.  It will also make your parent eligible for short- and long-term payment assistance.
  • Check the latest state inspection, which should be posted near the entrance to the home.  Make sure it’s there and current.  It’s important to take the time to read it all the way through.
  • Are the facility’s licensing and certifications current?
  • Make sure to get a complete pricing list.  You don’t want any surprises.  Find out the basic rates and specifically what’s included and what’s not.
  • Ask about the security and safety measures that are in place at the home.
  • Does the home appear to be clean and in good condition?
  • Do the rooms look comfortable and clean?
  • Does it pass the smell test?


Quality of Staff:

  • Watch how the staff interacts with the residents and how the residents respond.  Does the staff appear to be caring, respectful and engaged?  Does the staff seem friendly and competent?  Do the residents have an easy relationship with the staff?
  • What is the nurse-to-resident ratio?  How about the ratio of nurses’ aides to residents?
  • Does the home run background and reference checks on their employees?  What kind of training do the home provide?  Is the training ongoing and regularly updated?  How long does the average employee stay there?
  • Who is the staff doctor?  How often does the doctor visit?  (In the two different nursing homes that our dad stayed in, the doctor visited twice a month.)  And while we’re on the subject of staff doctors, be sure to ask if your parent can still see his or her own private doctor, as well as what local hospital would your parent be sent to in case of an emergency.
  • How often would your parent receive physical therapy?  Does the home offer occupational therapy?  (Occupational therapy focuses on practical daily activities, such as dressing, eating, etc.)  Do they offer speech therapy?  Walk around the therapy room(s) and watch the therapists interact with the residents.  Do they seem professional and knowledgeable?  Do the residents seem generally engaged and involved?
  • Ask the staff questions about how to care for your parent’s specific illness in order to gauge their level of expertise.  One of the reasons we chose our specific nursing home was because the physical therapists were eager to share ideas on how to help our dad.  It showed that they were not only well-equipped and knowledgeable, but enthusiastic about helping people.
  • Would your parent have the same staff each day?  Our dad preferred the same staff — he found comfort in the stability and, frankly, so did we.
  • Do the people working in the business office seem knowledgeable and competent?  Are they willing to assist with difficult paperwork?  Financing can be very complicated, and we learned the hard way how important it is to have knowledgeable people in the business office.


Quality of Life:

  • Are most of the residents up and dressed?  Are they clean and properly groomed?  Does it appear that most are well taken care of?
  • Is there space within the facility for your parent to enjoy a different atmosphere?  For example, our dad loved the ice cream parlor at one of the homes.  He also loved sitting by the water fountain in the courtyard (see the picture above).  We’ve seen homes with small libraries or rooms for quiet meditation.  It’s important to have some sort of area that’s different from the everyday environment — it helps to break up the day and to stave off a monotonous routine.
  • Ask to see at least a week of menus.  Do the residents have meal choices?  Try to be there for a meal so you can check out the food.  Does it look appetizing?  Does it smell good?  See if you can try out the food for yourself.  At the nursing home that our dad was in, they would let us buy our meal so that we could eat with him.  That was nice — having a meal together gave us a sense of normalcy.  Try to poke your head into the kitchen.  Does it seem clean and well organized?
  • What kinds of activities are available?  Look at the schedule.  If there’s an activity going on while you’re visiting, check it out.
  • What is the visitation policy?
  • Is your parent allowed to have a phone?  A private television?  What are the restrictions, if any, and what are the associated costs?
  • Ask for a copy of the Rules and Regulations that residents must comply with, as well as a copy of the Resident’s Rights.
  • Is there a resident and/or family council?  If so, how does that work?
  • Does the home have a barber/beauty shop on the premises?


To sum up, consider what’s essential to you and your parent and add those items to this list of requirements before you start your visits.

If you have time, select the two or three homes you like the best and visit them again.  Try to pick a different day and time.  The second visit is less emotional and will help you make a better selection.  The second visit is a good time to ask to meet with the head administrator and/or the director of nursing.  A talented and compassionate leader is important, and you should have a good feeling about the person in this job.

Here’s a tip:  Before you pick a nursing home, pick up a copy of A Spy in the Nursing Home by Eileen Kraatz.  This book is wonderful.  It’s easy to read, simply laid out, and it provides valuable information and insight into the selection process.  We also think the checklists are great.

Kim Keller is the co-founder of In Care of Dad.  She lives and works in New York City.


10 Responses to “What To Consider When Considering A Nursing Home”

  1. This is a great list. People may also want to consider if their nursing home has shuttle and transportation services for families. For NYC nursing homes it may be hard for families to get transportation but some facilities do provide shuttle services to make it easier to visit your family member.