When someone close to you needs a nursing home, it's time to do your homework.
Choosing a nursing home requires careful consideration of the person's needs as well as knowledge about what services are available and how well the home cares for its residents.
When possible, allow the person who needs care to help make decisions. It's his or her right to participate, and it may help with the adjustment to the nursing home.
To choose a nursing home, the National Institute on Aging and the Centers for Medicare & Medicaid Services suggest the following:
Check your choices. Is there a place close to family and friends? Do they offer the type of care you need?
Consider your assets. Don't depend on Medicare. It pays only for a limited period and only if a person goes directly to a nursing home from a hospital with a doctor's certification that daily skilled care or physical therapy is needed.
Medicaid may be available to some people with low incomes and few assets. You'll need to check eligibility through your state government, by visiting your state's Medicaid website, or by filling out an application in the Health Insurance Marketplace. It may take three or more months to determine eligibility. Be aware that not all nursing homes accept Medicaid.
Some people pay for long-term care with an insurance policy they've purchased or with their own savings for as long as possible. When they can no longer pay, they may get help from Medicaid. Be sure to ask any nursing home you are considering whether the person can continue to stay there if payment is from Medicaid.
Ask around. Talk with friends, relatives, social workers, religious leaders and healthcare professionals to find out what places they suggest. If it's important for the person to keep his or her own doctor, ask if the doctor makes nursing home visits.
Schedule a visit. Ask to meet with the home director and nursing director at the facilities you're considering. While you're there, ask to see the current inspection report and certification papers. Homes are not certified if they don't pass state inspections. Medicare and Medicaid will not pay for care in a noncertified home.
While you're visiting, look around. Does the facility appear clean and well-kept? Is it free from unpleasant odors? Is the temperature comfortable, and are noise levels acceptable?
Ask lots of questions. For example:
- How many people live in the facility?
- Is there a waiting list?
- Is there a choice of food items at each meal and a staff member to assist residents who need help?
- What kinds of activities are available—even for those who can't leave their rooms?
- Are personal belongings or furniture allowed in rooms?
- Does the home have arrangements with a nearby hospital for emergencies?
Staff also plays an important role. You could ask:
- Is there an ongoing training program for staff members?
- Does the same team of nurses and certified nursing assistants work with the same resident four to five days a week? Do assistants participate in care planning meetings? Can family members attend these meetings?
- Is a licensed doctor on staff who is there daily and can be reached at all times? Can residents have their own personal doctors visit them?
- Is a full-time registered nurse on duty at all times (other than the administrator or director of nursing)?
- Is there a full-time social worker?
- How long have the director and department heads (nursing, food and social services) worked at the home? Frequent changes in key staff could signal a problem.
Check for safety. You will want to consider the safety of the building itself. For example:
- Does the home have smoke detectors and sprinklers?
- Is there an evacuation plan in the event of a disaster, such as a fire, an earthquake or a flood?
Make a second visit. This time, visit without calling ahead. Try another day of the week or time of day so that you will meet other staff members and see other activities.
Read the contract carefully. If you don't understand everything, ask questions. Check with your state long-term care ombudsman if you want to learn more.
You may also want to check out medicare.gov/nursinghomecompare, a U.S. government website that compares the performance ratings of every Medicare- and Medicaid-certified home in the country. The 5-star rating system provides detailed information and a rating on every nursing home. It also contains information to help you make distinctions between high- and low-performing nursing homes.
Reviewed 11/28/2023