Last Revised: 08/067/2023

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.