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Overview

It is preferable to find a nursing home that: 

  • You can afford (whether through your insurance, your own money, or a government program);
  • Is located where you want to be (such as an area that is close to family members and friends so it is easy for them to visit, and/or near community resources you hope to continue to see and use);
  • Combines good “nursing” care with an atmosphere that is acceptable to you; and
  • Takes care of your wants as well as your needs.  

The steps to take to find the best nursing home for you are as follows. 

Step 1. Locate the nursing homes in the area you want to live in

  • Two sources for locating a nursing home are:
  • You can also find nursing homes through the following sources which may also be able to provide some insight about a particular home's reputation and what it is like to live there.
    • Your doctor
    • A hospital’s “discharge planner” 
    • Professionals in the long-term care field
    • Local non-profit organizations which relate to life threatening diseases. (Note: Feel free to call non-profit organizations that concern health conditions other than yours.)

Step 2. Narrow your list by checking existing data about the nursing home

For example, Medicare provides information about nursing homes and summarizes the information in ratings from one to five. Information is included about health inspections, staffing, fire safety and other quality measures. See: www.medicare.gov/NursingHomeCompare offsite link.

  • Once you find ratings for nursing homes of interest, you can look at more detailed information for up to three nursing homes at a time.
  • Keep in mind that the information on the site is reported by the nursing home. It is not generated by an independent inspection.

It may also be helpful to look at analyses of the federal data which can be found at:

The Joint Commission on Accreditation of Health Care Organizations, (JCAHO) provides accreditation to nursing homes and other health care facilities. To determine if a particular nursing home is accredited, see: www.qualitycheck.org offsite link

If you still have questions, you can contact your state's long-term-care ombudsman. The ombudsman advocates for nursing home residents. You can find your state's ombudsman at: www.ltcombudsman.org/ombudsman offsite link

Step 3. Call the nursing home and do a telephone evaluation

Once you have narrowed your search, it is time to start your own evaluation. If you start with a telephone call, you may eliminate the need to visit a particular home.  Some of the key questions to cover on the phone are:

  • Is the nursing home certified for participation in the Medicare or Medicaid programs? (This question is valid even if you are going to pay from private funds or via a long-term-care insurance policy.) 
  • Does the facility have vacancies or is there a waiting list? 
  • Is there space available for you under your payment plan?  Nursing homes are known to allocate beds between people paying full market rates and those on Medicare or Medicaid. 
  • What are the facility’s admission requirements for residents? Do you fit them? 
  • What is the typical profile of a resident?  For example, does the nursing home specialize in particular diseases? 
  • Does the facility follow Green Home principles? The Green House Project seeks to create a more homelike atmosphere in long-term-care facilities. In addition to a homier feeling, the movement calls for more patient centric care. To learn more about Green Houses, see: www.ncbcapitalimpact.org offsite link.  Then click on "Site Map", then click on "Community-Based Long-Term Care. 

NOTE: If payment is going to be through Medicare or Medicaid and there are no beds available for such payment methods: consider paying the market rate for several months and then switching to Medicare/Medicaid payment. It is difficult to move people out of a nursing home once they are in.

Step 4. Do at least one on site inspection - and preferably more.

Once you have narrowed your search, inspect the facility with a family member or friend to determine what life would be like living there. Ideally, visit the home several times. The concept is to get the idea of what a typical day is like. If you’re not up to it, ask a family member or friend to do it for you. Choosing the best home for your needs is too important a decision to leave to chance.

Preferably:

  • Do not announce your visits in advance so you see what things are like when staff is not on their best behavior.
  • Do not judge a facility by your first impression.

 If there isn’t time to do an inspection, be sure the information you receive about each home under consideration comes from a broad base of sources. Do not rely on any one source in making a decision about a nursing home.

Click here for a list of  questions to help you focus on things that will be important to you if you become a resident.  Feel free to print the list and take it with you or give it to whomever will visit the site for you. You can then write down your observations for each home visited so you can make a better comparison later.  

Bottom LineForm your own impressions. After you have done all of your research, your final judgment should include your “gut feeling.”

 Step 5. Ask a lawyer to review the contract.

If a nursing home facility uses contracts, have it reviewed by a laywer specializing in elder law. Look for terms that are important to you. For instance:

  • Can residents see their own doctor or are they restricted to doctors from the homey?
  • If your health condition gets worse, who makes the determination that it is time to move to a hospital?
  • If you have to pay money up front:
    • Is it refundable? 
    • If not fully refundable, is there at least a prorated refund in case you’re not happy there? If so, what are the terms?
  • If the contract is for a minimum term, what if you are not happy in the facility after living there for a while?
  • Who is responsible for scheduling and administering medication?
  • Does the home  permit you to use your own pharmacy or do you have to use theirs? Who is responsible for administering and coordinating your medications?
  • The place in which you will live:
    • Does the contract specify a specific unit you will live in? 
    • Can you bring your own furnishings? 
    • Is the same unit guaranteed on your return after a stay in a hospital?
  • Are there limitations on who can come to visit you?
  • Meals
    • Which meals are included?  
    • During what times?
    • Will the facility provide a special diet if you need one?
  • What does the contract provide about transportation? For example, to and from doctor appointments or for treatments. 

For :additional information see:

NOTE: Consider meeting with a geriatric care manager who can complete a clinical assessment and make a recommedation for an apropriate level of care and about particular nursing homes.

Suggestions For A Site Visit Of A Nursing Home

The following suggestions are based on a Consumer Reports article on Nursing Homes together with the recommendations of the New York State Department of Health. The list is extensive to provide questions to help you focus on things that will be important to you if you become a resident. Add whatever matters are of particular concern to you before you visit any sites so you do not overlook them. Photocopy the list with your additions. Take the list with you or give it to whomever will visit the site for you. Write down your observations for each home visited so you can make a better comparison later.  

Bottom LineForm your own impressions. After you have done all of your research, your final judgment should include your “gut feeling.”

 Inspection Report:

  • If you haven’t already received a copy of an inspection report, ask for one on site. 
  • Ask how any problems have been corrected. (If you ask to meet with the nursing home administrator, you will not only get answers to this question, but you can also ask about the philosophy behind the nursing home.)
  • Federal guidelines require nursing homes to make their latest inspection report available and readily accessible to residents and the public. Still, sometimes you have to be assertive to get a copy of the report. 

 Visits:

  • Tour each nursing home on your own rather than with a staff member. If the home won’t let you tour alone after the first guided visit, take it off your list.
  • Make unannounced visits. 
    • Ideally the visits should be at different times of the day and week to get a complete view of life in the home. 
    • One of the visits should be during the evening and/or on a weekend when there are usually fewer staff members on duty.

 Physical Appearance:

  • Does the nursing facility allow residents to personalize their rooms?
  • Does each resident have at least one comfortable chair?
  • Does each resident have his or her own dresser and closet space with a locked drawer or other secure compartment?
  • Is there an out-of-doors area where residents can walk and sit and is it used?
  • Does the equipment appear to be in good condition? For example, wheelchairs and assistive devices.
  • Is there a lounge or other area where residents can entertain visitors privately?

Safety:

  • Are the exits clearly marked and unobstructed?
  • Are there features geared toward accident prevention? For example, handrails in the hallways and grab bars in the bathrooms.
  • Are the hallways wide enough for two wheel chairs to pass? Can they pass freely everywhere or are there obstructions?
  • Are there safety hazards to people who walk unsteadily or with impaired eyesight?
  • Is there good lighting?
  • Telephones;
    • Are there any restrictions on mobile phones?
    • Are telephones placed so that wheelchair-bound residents can make use of them?
  • Are inside temperatures appropriate? Are residents dressed appropriately?
  • Are people assisted in walking for the purpose of exercise or retraining?

Cleanliness:

  • Check the kitchen for cleanliness.
  • Check for smells (particularly for urine and feces).
  • Look at the overall cleanliness of the public and activities areas.

 Residents:

  • You may be able to judge how successful a home is in caring for residents by observing residents without infringing on their privacy.
  • Look at the quality of the care and concern for residents.
  • Are residents allowed to set their own schedules?
  • Ask residents:
    • What they like like about the home.
    • What they don't like about the home.
    • What they do when they need something to be different. 
    • What they like about the staff. 
  • Ask visitors or volunteers the same questions you ask residents.
  • Do the residents appear to be content, enjoying the activities, interacting with each other? Are they well groomed?  If most residents are passive, it may be a sign that the home has no activity program or that residents are kept on medications.
  • Are any of the residents in restraints? If so, ask the staff why. 
    • Federal law states that nursing home residents have the right to be free from any restraints administered for purposes of discipline or convenience, unless required to treat medical conditions.  
    • In addition, federal law states residents have the right to be free from neglect and any type of abuse – verbal, sexual, physical and mental.
  • Do staff interact with residents in a warm, friendly manner?
  • Do staff address the residents by name?
  • Are residents allowed to participate in the planning of their own treatment?
  • If possible, speak with family members of the facility’s residents. There may even be a voluntary council of family members with which you can speak. 
  • Does the home give residents the freedom and privacy to attend to their personal needs?
  • Are there arrangements for residents to go home for holidays?

Staff:

  • Is a consistent team of doctors and nurses assigned to each resident? (Consistency increases staff familiarity with individual cases and needs, and reduces medical errors.)
  • How responsive is staff? Do staff respond to someone calling for help?
  • Visit the activities area when in session and notice how staff interacts with residents.  
  • Walk through the corridors and listen to what you hear.
  • Try to get a handle on staff turnover if you can. A high rate of turnover is not good.
  • Find out who to speak with if problems arise, and meet with that person.

Food:

  • Try to time a visit for meal time. Taste the food. Is food appetizing and of good quality?
  • What arrangements does the home have for special diets? 
    • Is there a dietitian? 
    • What effort is made to make special diets taste good?
  • Is there sufficient staff and equipment to help residents who canot easily feed themselves? 
  • Is sufficient time allotted for eating?
  • Is food delivered to residents who are unable or unwilling to eat in the dining room? 
  • Are snacks available?
  • Is the dining room clean and attractive?

Medical/Nursing Care:

  • Look at the medical services, since medical and nursing care is crucial. Generally, you choose your own doctor, even for emergency care. Nursing homes also have their own doctor. Find out:
    • Who the doctor is 
    • The doctor's qualifications
    • How often the doctor visits and reviews residents’ medical records.
  • What care is given by a registered nurse and what care is given by an aide?
  • How many residents is each nurse’s aide or direct care nurse assigned to care for? 
  • Are licensed nurses on duty around the clock?
  • Does the same nurse or aide care for the resident during each shift?
  • Will your attending doctor be able to care for you while you are in the facility?
  • How are medical emergencies handled?
  • If you need more than routine medical care, ask:
    • If a specialist can be called in.
    • If so, how is this done?.
  • In case a medical condition calls for it, with which hospital or hospitals is the nursing home affiliated?
  • If you may need special therapy:
    • Look in the therapy rooms to assess the physical quality.
    • Speak with the staff person in charge to find out if there is any rapport between the two of you.
    • How frequently will the therapy be offered? 
    • How much involvement is there from the doctor with respect to the establishment and oversight of the therapy?

Activities Programs:

  • Ideally, a program should be designed to fit the interests and skills of each person at a variety of times on a daily basis, including weekends.
  • Are residents taken out for events in the community?  
    • If so, how often? Where do they go?
  • Do people in wheelchairs get to participate?
  • How often are outside events brought in for the entertainment of residents?
  • What activities are provided for bed-bound residents?

Money Issues:

  • Find out what services the home provides and which ones cost extra.
  • How much does the nursing home charge for: 
    • A daily semi-private or private room if you need one.
    • The “extras”. For example, supplies such as diapers, catheter tubes and for special services like incontinence care. A daily rate seldom relates to the charges for the extras. Be prepared to supply the “extras” you need yourself.
  • Does the nursing home require that a resident sign over personal property or real estate in exchange for care? If so, how much?  

NOTE Prescriptions in nursing homes often cost double what they would at a local pharmacy. If the drug prices are gouging, demand the right to purchase drugs outside the nursing home.