How to Choose a Nursing Home: The ‘Do’s’ of Due Diligence

The process of selecting a nursing home for a loved one can be both daunting and frustrating—and sometimes even contentious if many family members are involved. “Most families do this in a time of crisis,” says Toby S. Edelman of the Center for Medicare Advocacy, a nonprofit education and advocacy organization. “It’s very difficult to choose.”

But with diligent research and a hands-on approach to vetting the nursing home candidates, you can assure yourself and your loved one that you avoided questionable choices and did the best you could.

It may, of course, be both prudent and advisable to search out alternatives to a nursing home—most families do. Older Americans' shift to remaining in their own homes as they age is bolstered by an ever-widening array of options for receiving home- and community-based care.

If you decide to look into nursing homes, her are some pointers to help guide your search:

Know your rights. Hospitals seeking to discharge patients will recommend nursing homes, but often without leaving families enough time to investigate candidates, says Charlene Harrington, a professor of sociology and nursing at the University of California, San Francisco. “Most people don’t know that they can stand up to discharge planners and ask for more time,” Harrington says. “And they can also appeal the planners’ rulings.” (See the Family Caregiver Alliance’s Strategies for Working with Discharge Planners.)

Avoid easy answers. Many families begin their search online at Nursing Home Compare, which is operated by the Centers for Medicare & Medicaid Services (CMS). This government website lists every nursing home in the United States that receives funds from Medicaid or Medicare and provides basic data drawn from federal and state inspections. But critics of the site—including Consumer Reports magazine and Sen. Charles Grassley, R-Iowa—say that it provides inadequate information about nursing homes and is sometimes even misleading.

On the plus side, however, Nursing Home Compare can offer a good start in eliminating facilities that show serious deficiencies or worse, have an SFF tag—meaning that they have had chronic serious problems and are therefore on the Special Focus Facility watch list.

Look online for information about specific nursing homes. One starting point may be the Nursing Home Quality Monitor produced by Consumer Reports, which offers state-by-state listings of facilities to consider and to avoid. Two other potentially useful sites are SeniorDecision.com, which features user-posted reviews of nursing homes and other care providers, and MyZiva.net, which presents CMS data in easy-to-understand formats.

Visit, and visit again. The most important element of the selection process, according to the experts, is a personal visit—preferably more than one—to any nursing home you’re considering. “Ask yourself, ‘Does it feel like a home?’ ” advises Susan Reinhard, a senior vice president of AARP’s Public Policy Institute. “What would it feel like to live there? Is there any laughter? Are there any odors? Is it safe but not too sterile? Are there people visiting? Are children visiting? Is it integrated with the community?”

Make a comprehensive checklist. To add the most value to your in-person visits, it pays to make a checklist in advance. Medicare has a detailed Nursing Home Checklist, and AARP offers a Nursing Home Evaluation Checklist.

Many state agencies and nonprofit organizations offer sample checklists as well. The National Citizen’s Coalition for Nursing Home Reform, for example, includes an extensive checklist in its Consumer Guide to Choosing a Nursing Home. Some sample questions: Do resident rooms appear to reflect the individuality of their occupants? Does the facility provide transportation to community activities? Does the facility respect the resident’s wishes about their schedule (bedtime, baths, meals)?