4 Steps to Finding a Nursing Home

And Questions to Ask

Last Revised: 12/07/2022

The 4 Steps

Step 1: Learn about nursing homes options in your area.

Step 2: Compare the quality of the places you are considering.

Step 3: Visit the places you are considering.

Step 4: Choose.

Nursing homes, also called skilled care facilities, typically provide nursing care, 24-hour supervision, meals, assistance with daily activities, and rehabilitation services. It’s common for people to stay in a nursing home for a short time after being discharged from a hospital. Many people stay in a nursing home permanently, so they have access to continuous support for ongoing physical or mental conditions.

Skilled nursing care often includes 24-7 supervision, medical attention, meals, and help with daily living activities.

Medicare, through Part A (Hospital Insurance), can cover care in a certified skilled nursing facility if the care is medically necessary. Medicare may also cover short-term nursing stays following hospitalization, and some home- and community-based long-term care. Medicare Part A does not cover general assistance and support services or long-term care in a nursing home. Medicaid may cover long-term nursing home stays, and home- and community-based services.

Top Resource: Medicare offers a “Guide to Choosing a Nursing Home” and a nursing home checklist to help people choose a facility, including a Spanish version to help people who are not fluent in English.

Step 1: Learn About Nursing Homes in Your Area

There more than 15,000 Medicare and Medicaid-certified nursing homes in the U.S. Each state health department maintains facility files, survey results, and reports of complaints. Another often overlooked way to find a local nursing home is by asking neighbors and friends. Local community and senior centers are also a good source of information. You might even ask the person’s doctor if there is a specific nursing home where they provide care.  

Cost: the national average cost of nursing home care in 2021 was $7,908 to $9,034 monthly for a semi-private to private room according to the Genworth Cost of Care Survey

Step 2: Compare the Quality of the Places You Are Considering

Use the Nursing Home Compare tool by Medicare to review the surveys for each facility you are considering.

Secret Tip: Call the Long-Term Care Ombudsman in your State for information about specific facilities.

Step 3: Visit the Places You Are Considering

Taking a Tour

During Covid, many nursing homes severely restricted on-site tours, replacing them with virtual or video tours. If at all possible go to the facility. You learn much more about how patients are treated when you can see, smell, and hear what’s going on than via a video tour.  

Make plans to meet with the Director and Nursing Director and walk through as much of the nursing home or community as possible. Look for how well the facility is maintained, if people are engaging with each other and activities and look well groomed, are there any bad smells, are the colors and decorations pleasing, is the furniture well-maintained?

Questions to Ask and the Answers You Should Hear

Q1. How long has the Director of Nursing been working at the facility.

A1. At least 3 years. Preferably 5 to 10 years.

Q2. What is the turnover rate for Nurses’ Aides during the last two years?

A2. If the turnover of Nurses’ Aides is every 3 to 6 months or more than two per year the continuity of care is at risk.

Q3. Does my current doctor serve the facility?

A3. Yes.

Q4. How often does the facility’s doctor visit each patient?

A4. Most facility doctors visit each resident at least once a month. Weekly visits are optimal.

Q5. Is an RN available 24/7?

A5. Yes.

Q6. How many RNs, CNAs, LPNs, and APNs are there for each resident during day and night shifts?

A6. One healthcare professional (RN, LPN, CAN, APN) for every 12 residents in a skilled care facility is a minimal expectation.  Ratios of 1 to 8 are optimal.

Q7. Is the nursing home accredited?

A7. Yes, means that they have taken extra steps to ensure the quality and safety.

Q8. How do you help people with dementia?

A8. Our staff has special training on working with dementia. We also have consistent assignments among the staff so new people are not continuously introduced to people with dementia.

Q9. What type of access do residents have to rehabilitation and therapists on-site?

A9. We have licensed therapists on-staff.

Q10. What is your policy regarding using agency nurses and health professionals?

A10. Listen for “only our employees and care partners work here” unless there is an emergency.

Q11. How do you measure resident and family satisfaction?

A11. Listen for a response that includes regular surveys, one-on-one meetings, and family group meetings.

Q12. What recreational and social activities are offered, and how are special needs accommodated?

A12. Top facilities have certified social and recreational directors are on staff, and that they will work to accommodate any special requests from residents.

Q13. How will you get to know my family member?

A13. Higher quality facilities will start with a new patient questionnaire, and then follow up with a person-to-person interview to explore your loved one’s preferences. That should be followed by introductions to key staff at the facility.

Q14. How are my loved one’s dietary or food preferences met?

A14. Look for a well-planned menu and flexibility if a resident does not like the main entrée. Also, look for a limited after-hours menu so residents can eat when they want. It doesn’t hurt to ask to see a menu.

Q1. Is transportation provided to run errands and for activities?

A15. Often there is a scheduled time where transportation is provided each week for errands and activities.

Patient Guidelines: Questions to Ask Your Doctor

Last Revision: 10/10/2022

medical-decisions-v2You can prepare for any doctor appointment by 1) writing down the questions you have for the doctor in advance, and 2) bringing pen and paper or a recorder to jot down/record  answers and take notes. if you bring a recorder let your doctor know that you are recording the conversation so you don’t forget anything. If the doctor objects, find a better doctor.

Here are questions you might want to ask:

  • What do think might be wrong with me? How do you know?
  • What are the common causes of this problem?
  • Can I self-treat this problem or condition?
  • Will I need any tests?
  • Which tests might I need?
  • What does each test involve?
  • How do I prepare for each test?
  • Will my insurance pay for the tests?
  • What are my treatment choices?
  • What are the benefits and risks of each treatment?
  • What are the side effects?
  • What are the likely outcomes of each treatment?
  • Which treatment is the most common for my condition?
  • What is the recovery like?
  • How will my life change with this diagnosis or treatment?
  • What is the likely outcome if I choose not to have any treatment?
  • What would be the “next steps” if treatment fails?
  • What kind of medication(s) must I take? For how long?
  • What does the drug do? Will there be any side effects?
  • What should I do if I have side effects?
  • Can I take a generic version of the drug?
  • Will the medicine interact with any I am already taking?
  • Should I avoid any kind of food or activity while taking this medicine?
  • Will I need to see a specialist?
  • Should I get a second opinion?
  • Do I need a follow-up visit?

Don’t hesitate to ask any other questions. You should also prepare questions for any hospital where you will be treated, as well as surgeons, specialists, other clinical healthcare providers, and insurance providers.


You just got the news that you’re very sick. To ensure your quickest, safest, and best outcome you must be actively engaged and lead you own care. As soon as you can balance your emotions, you will have to make important decisions about your doctors, treatment, care, and finances.

Click here for an even more detailed step-by-step explanation of each step.


During the next few days, weeks, and months you must learn enough about your choices to make informed decisions. Likely, your doctor or health insurance provider has provided or will provide information specific to your diagnosis. This might be a pamphlet, web page, video, support group, app., or something else.


It will take time before you have processed your new diagnosis and balanced your emotions. It may take just a few days or several months. There are a wide range of emotions that people feel after getting a serious diagnosis. It’s important to realize that these feelings are all natural. It’s common to feel grief shock, anger, frustration, worry, and other emotions. It’s also common for people of any age to experience short-term changes in behavior after hearing such serious news.  Be reassured that in most cases your emotions and any physical changes like loss of sleep or diet are temporary. They typically start returning normal within weeks when there is support.  

KEY TIP: Science shows that you increase your chances for positive outcomes when you find at least one person, or a support group, you trust to talk to.

When you walk this journey alone, you increase the risk of things not working out for the best for many reasons. If there is no one in your life that you trust enough, consider finding comfort and support by seeking out and communicating with others who have experienced a similar diagnosis, and often recovery.

Shyness doesn’t matter in these groups. You can stay anonymous and just listen and learn from other posts and replies. Sometimes the comfort of being anonymous also lets you express your feelings to others who you hardly know, because you have shared a common experience.

You may also connect with care givers and family members as well as patients, both current and past. Support groups are often available in-person in most urban areas and online for anyone with a smart phone and/or Internet access. Here’s a link to hundreds of local and online support communities organized alphabetically by diagnosis.

KEY TIP: Trust, but research and verify everything you learn in chat rooms with your physicians and through published, peer-reviewed research and patient use cases.

If you’re emotions have not begun to balance within 30 to 60 days engage the support of your doctor. You’ll make better decisions once your emotions settle. It also is not advisable to make any immediate decisions regarding your health unless your doctor tells you that you must act quickly. If you must make a quick decision, seriously consider a second opinion from another clinician or experienced provider in as short a time as possible. You can stay within your network for the lowest cost or seek out world renowned clinicians at providers like the Cleveland Clinic, Stanford Health Care, and other major health centers for virtual second opinions within days.

KEY TIP: It’s a best practice to always contact your health insurance provider and ask questions until you understand any cost to you, and what you can do to get the lowest cost, highest quality care.

If your reactions to your diagnosis do not get better within a few weeks or if they get worse, ask your doctor about mental health counselors and support that is available. Click here for an even more detailed step-by-step explanation of each step.

Last revision: 08132022

As of July 16, 2022 – “988” Suicide and Crisis Lifeline providing 24/7, confidential support

As of July 16, 2022 all calls and text messages to “988” route to a 988 Suicide and Crisis
Lifeline call center. The 988 Suicide and Crisis Lifeline – previously known as the National Suicide Prevention Lifeline – is a national network of more than 200 crisis centers that helps thousands of people
overcome crisis situations every day. Here’s a link to the “988 Fact Sheet;” http://chrome-extension://ieepebpjnkhaiioojkepfniodjmjjihl/data/pdf.js/web/viewer.html?file=https%3A%2F%2Fwww.fcc.gov%2Fsites%2Fdefault%2Ffiles%2F988-fact-sheet.pdf

New Study: 93% Reduce Medical Bills by Negotiating

Connect to free help with your healthcare

A recent study by LendingTree found that 93% of the people who negotiated a medical bill reduced their bill or had the charges completely dropped. Learn how to negotiate by reading Patient Guidelines: Managing Medical Costs.

The article includes step-by-step instructions for lowering costs, where to find help, fighting insurance denials, managing surprise and high-cost bills, getting an itemized bill, checking bills for errors, using a billing advocate, negotiating fees, price shopping, finding low-cost care, raising money for medical expenses, medical tourism, and more cost-saving tips.

All Older Americans Need a Durable Power of Attorney (DPOA)

So many times you hear a story about a family member or friend who is trying to arrange for the care, payment of services, or other needs for a loved one and the provider or business will not speak with them. This happens way more often than you might think, and it can happen fast.

Consider what could happen if your loved one, who currently lives an active life in their home, fell and required hospitalization, rehabilitation, and eventually long-term care. What if they become fragile, are heavily medicated, battling other illnesses, or they are on a downhill slide? How will you know that their preferences will be heard and acted on? Will they be at the mercy of a very broken, over-whelming and fragmented health care system, or will there be someone to step in and help make sure that their preferences are executed?


A Power of Attorney (POA) is a legal document most commonly giving one person (the “agent”) power to act for another person (the “principal”) when the principal is not able to speak or make decisions for themselves. A POA that is not modified by the “principal” or overridden by a court lasts until the death of the principal. A POA can also be limited by the principal and grant the agent specific authority to execute a task like selling a car or property.

The agent is always expected to act in the principal’s best interest. Agents can have broad or limited legal authority to make decisions for and execute contracts for the principal about property, finances, medical care, and other issues. An agent cannot change the principal’s will, make decisions for the principal after death, or change the POA to another person or agent. Finally, although not common two or more people can have POA. The POA needs to be “Durable” to remain in effect after the principal becomes incapacitated or dies. If the POA does not specifically say it is durable the POA ends when the principal becomes incapacitated. It’s possible although not common to give two or more agents your POA.

Critical Tip: Third parties, especially banks and financial institutions, have frequently challenged the authority of an Agent using a POA. In these types of case the courts are used to order the third party to honor the POA.


When a POA is not acting in the principal’s interest, it may become necessary to override their authority. This is done by filing a petition in court challenging the agent. If the court finds the agent is not acting in the principal’s best interest, it can revoke the POA and appoint a Guardian.

Elder Law attorneys are very helpful when trying to understand how to execute and use a POA based on your circumstances. They often provide an initial consultation for no charge. Although free POA forms are available online there are many issues to consider. We recommend using a qualified, local attorney 100% of the time.  The National Academy of Elder Law Attorneys will help you find the right attorney. Spare yourself and your family the pain and anguish of trying to help a loved one when they need it most. Learn about POA and DPOA. Find a local attorney to help you execute the right tool for your needs. This will help you keep control of your loved-one’s safety, care, and quality of life, and support your own well-being as well.

Healthcare Consumers Win Hospital Pricing Transparency & Balanced-Billing Protections

Last Revision: Dec. 30, 2020

American healthcare consumers have won two recent and hard fought victories for hospital pricing transparency and an end to surprise medical bills from a practice called “balanced-billing” that enabled out-of-network providers to send bills to people for the amount that insurance did not cover.

Hospital Pricing Transparency

Once again the healthcare power players, this time the American Hospital Association (AHA), tried to block consumers from accessing  transparent information about their prices. Fortunately, U.S. District Judge Carl Nichols in Washington, D.C. dismissed the AHA’s challenge to a Centers for Medicare & Medicaid Services Price Transparency  Final Rule requiring them to disclose the prices they negotiate with insurers.  The rule will take effect beginning on Jan. 1, 2021. Count on the AHA to appeal to continue their efforts to block informed decision-making by consumers. You can follow the case “American Hospital Association et al v Azar, U.S. District Court, District of Columbia, No. 19-03619.

New “Balanced Billing” Protections

While consumers will still have to deal with high prices for prescription drugs and certain health care services, at least they will now be protected against unexpected bills from out-of-network providers of emergency care, air ambulance transportation, and nonemergency care at in in-network hospital when unknowingly treated by an out-of-network provider, including anesthesiologist and laboratories. This bill does not cover ground ambulance services.

The bill does include provisions for consumers who want to use an out-of-network provider and are willing to forfeit protections to see the provider of their choice.

Consumers need to be aware that this new law does not go in effect until 2022.

Blood Glucose Accurately Predicts COVID-19 Severity

The Nov. 23 issue of Annals of Internal Medicine published an observational study that concluded that hyperglycemia (blood sugar level) independently predicted progression from noncritical to critical condition and death, regardless of prior Diabetes history,  among more than 11,000 patients with confirmed COVID-19, from 109 hospitals in Spain. This study informs how people admitted to a hospital even with mild hyperglycemia should be treated. Since it examines outcome by admission blood sugar level it eliminates the effect of any inpatient treatment.

2021 Step-by-Step Guide for Comparing Health Plans

Revised: Nov 30, 2020

Your health insurance decision can impact your health and finances for the year.

Choosing the right insurance is a judgement call based on what is covered, what is not, how much flexibility you want, and how you prefer to spread health care costs throughout the year. The content is adapted from the Patient Advocate Foundation (PAF) step-by-step guide. The work sheets help you organize your needs and compare plans on the Exchanges.

4 Steps to get you started.

Step 1

Gather the names of the doctors that are important to you now and all the prescription medications you are taking. This will be helpful to make sure that the plan
you choose covers your preferred doctors and medications. This planning can also help you avoid unexpected costs. The worksheets provided will help you organize the information
needed to compare plans.

Step 2

Enter the requested information about you on the official Health Insurance Marketplace website. Enter your zip code to find plans in your area. You may be
redirected to a different web page if your state runs its own exchanges.

Tip: Plans may be more affordable than what you first see in the estimates. Depending on your income level, you may be eligible for financial assistance that helps pay part of your
premium. To find out more about this assistance (called “estimated savings”), enter your annual household income before comparing plans to see rates personalized for you.

Step 3

Use the filter feature to narrow down the plans to a manageable number for comparing. Some options you can filter by:

• Monthly premium: select a reasonable range you can afford for this recurring fee.
• Yearly deductible: consider the amount you can afford to pay up front for medical care before the insurance kicks in to cover costs.
• Medical providers and prescription drugs: see which plans cover your preferred doctors, pharmacies and the medications you take.

Step 4

Pick a few plans you want to compare and use the worksheets provided below to help identify which ones meet your particular needs. To calculate your full expected costs and see
more plan details on healthcare.gov, select a plan, then click Plan Documents and you will find the following:

• Summary of benefits and coverage outlines what the plan covers and the costs you would be responsible for paying.
• Provider directory is where you can check whether your preferred doctors, hospitals and other facilities (like labs for bloodwork) are included in your plan, and
• List of covered drugs (called a “formulary”) provides information about prescription medications that are covered under the plan and the tier level, which
determines how much you would have to pay out-of-pocket to get your prescription.

Doctor and Hospital Considerations

The doctors and hospitals that are covered in the plan (called “in-network”) may change each year, so you’ll want to check that they are still in-network. This is a good time to think about any
changes you would consider, including the possibility of seeing a different doctor. If your doctor is not covered in-network, would you be willing to see another doctor or visit
another facility that is in-network? If no, does the plan pay anything towards the costs of seeing doctors or visiting hospitals that are out-of-network? You may still be able to see that doctor,
but it is likely that you will pay a higher out-of-network cost or be responsible for 100% of the costs. You can also contact your doctor’s office to ask about any special arrangements that may
be offered if the practice is not participating as covered providers on the insurance plans that you are comparing.

Prescription Medicine Considerations

This is also a good time to review with your doctor all the medications you are taking. You can go through your list of prescriptions, the amount you are spending for each, talk about how
these medications make you feel, and discuss whether any changes are needed. In some cases, a more effective or lower cost medication may be available, or your doctor may suggest
discontinuing some prescriptions that are no longer needed.

Doing a medication review annually with your doctor will help you get the best care possible and may also help you reduce your out-of-pocket spending on prescription medicines. You may
have the option to save money by switching from a brand drug to a generic drug. If you want to learn about cost-saving options that may apply for your medication, review this PAF resource
about drug tiering.

If you have been diagnosed with a complex or chronic condition, Patient Advocate Foundation’s (PAF) case managers can help guide your plan choice process.
The worksheets provided below can help you prepare for your conversation with your doctor’s office or with PAF case managers.

For personalized help, go to http://www.patientadvocate.org or click here to fill out the PAF request for assistance form.

You can also visit the PAF National Financial Resource Directory to find nationwide financial assistance support for medications, other health care needs and non-medical daily living

Worksheet 1. Your Doctors

List the names of each doctor and specialist important to you. For example: List out your primary care doctor, OBGYN, oncologist, psychologist

Worksheet 2. Your Hospital and Facilities

List the hospitals or facilities that you would want to go to for a planned procedure or an emergency in the numbered boxes below. For example: labs, outpatient centers,
urgent care, or emergency department.

Next to each name, write yes or no to indicate whether your doctors and specialists are included in the provider directory for each plan you are comparing.

Write yes or no to indicate whether the hospitals or facilities are on the provider directory list.

Worksheet 3: Your Medications

List all the medications you take in the numbered boxes below. For each prescription, check the list of covered drugs (called the “formulary”) and write yes or no to indicate
whether your medication is included in the formulary. You may also want to note which cost tier the medication is listed under to compare that information across the plan

Worksheet 4: Your Costs

To estimate the total costs associated with the various plan options and how it relates to your particular financial circumstances, list below the fixed costs each year that you
would be responsible to pay in monthly premiums, annual deductible and annual out-of-pocket limit (or maximum). Along with your out-of-pocket costs, these are the
numbers that matter when determining what you can expect to pay in total for the year. This information can be found in the plan’s Summary of Benefits and Coverage
document (sample here from the Centers for Medicare and Medicaid Services.) It’s difficult to know exactly what costs may occur ahead of time, especially if you receive an
unexpected diagnosis. But based on what you know about your finances and circumstances, it helps to try to estimate what you feel you can afford, so you select the
best coverage option for your needs.

1. Monthly premium ($ per month): Account for any estimated financial assistance you may be eligible for to help offset your costs. You can
estimate this here. Actual financial assistance is determined when you apply for coverage.
2. Annual deductible ($ per year) The amount you pay up front before the insurance starts to pay for care. Check if there are separate
deductibles for specific services or medications.
3. Out-of-pocket limit or maximum ($ per year) This is the maximum amount you would have to pay in total each year. It does not include premiums or
money spent on non-covered services. In addition to these fixed costs, once you have reached the deductible, you will have to pay a portion of medical expenses when you get care (called “cost sharing” or “out-of-pocket costs”) through either the copayment (a flat $ dollar fee) or coinsurance (% percentage of cost). Before this point, you will be responsible for whatever the doctor or hospital charges you on your own.

Below are some of the services you may need, but review the Summary of Benefits and Coverage to see how much you would pay for various other services.

4. Doctors ($ or %) – Primary care provider who you see for annual checkups.
5. Specialists ($ or %) – Specialty doctors like dermatologists, rheumatologists, or oncologists.
6. Hospital stay (%) – Emergency room care and facility fee if you must stay overnight.
7. Prescription Medicines per fill ($ or %). This depends on a few things like the plan’s formulary and what tier the medicine is placed on. Learn about the tiering options and how to request an exception at this PAF resource.

Bringing it All Together and Choosing Your Plan

Evaluate each plan against what you have determined are important doctors, medical services and prescription medicines to be covered, and your budget. Consider whether
you can afford the fixed costs (monthly premiums and deductibles) but also the cost sharing (coinsurance and copayments) when you receive care. While you typically won’t
pay more than the maximum out-of-pocket limit, consider whether you can afford to shoulder the upfront costs and pay the deductible over a short period of time if an
emergency arises.

Tip: Look at the plan’s monthly premium, annual deductible and cost-sharing as three equally important components affecting your total costs. For example, if a plan’s
monthly premiums are very low, then the deductible or copayments may be higher. Weigh these three components carefully aiming to strike the right balance for you before
selecting a plan.