How to Find a Nursing Home

Sending a loved one to a nursing home is one of the hardest decisions a person will have to make.  The many options can be overwhelming, and the number of nursing home “horror stories” doesn’t make the choice any easier.  But with research and determination, it is possible to find a good nursing home.

Nursing homes can be like hospitals or like households.  In the hospital-like setting, staff provides medical care, occupational therapy, and speech therapy.  There is usually a nurses’ station on each unit.  In the household-like setting, the environment is much more like a home.  For example, residents can use the kitchens and do activities on their own schedule. (NIA).

Federal law requires certified nursing homes to have at least one Registered Nurse for at least 8 hours a day, 7 days a week.  An RN or Licensed Practical Nurse (LPN) must be on duty 24 hours.  Certified Nursing Assistants (CNAs) are on staff 24 hours a day.


The Centers for Medicare and Medicaid Services (CMS) inspect the more than 15,000 nursing homes in the United States.  If the nursing home doesn’t pass inspection, it isn’t certified.  The nursing homes are then ranked based on health inspection, staffing, quality measures, fire safety, and payment options, with a score of one to five stars.  The Medicare and Medicaid government website to compare nursing homes in your area is found here.

Only the top 10% of nursing homes in each state are given a five-star rating.  However, this could be misleading the data gathered are from a short period of time.  Additionally, many four-star nursing homes could be very similar to five-star nursing homes, just a couple points shy of the 10% cut-off.

The website provides information on nursing home comparisons, checklists, payment options, resident rights, and other useful information.  They also offer a useful brochure and nursing home checklist.

The Visit

One of the most important parts to choosing a nursing home is visiting it.  Even if a nursing home looks good on paper, if it smells like urine it may not be a good choice.  It is important to observe the staff and their interactions with each other and with the residents of the nursing home.  After your first visit, make a second visit unannounced, but at a different time of day than you did before.  Observe residents at mealtime to see if they like the food they are eating.  (NIA).

During your visit, has a list of things to look for:

  • Are there unpleasant odors?
  • Are residents clean, dressed, out of bed, and interacting with staff?
  • Is the noise level unusual?
  • Does the facility look clean?
  • Does the home seem like a safe place to live?
  • Are residents involved in activities?
  • Are staff visible, helpful, friendly?
  • Does the home “feel” warm, as a home should?

It is a good idea to meet with the head nurse and physician if possible, as well as the director of the nursing home.  If they are constantly unavailable or unable to meet with you, it could be a bad sign.  Also talk to the nurse assistants, dietary staff, and activity directors.

Ask the nursing home what percentage of staff leave each year.  30% is considered normal, 50% may be a bad sign.

“Person-centered care” and “consistent assignment” are two terms that may signify the nursing home is a good choice.  Person-centered care means that the nursing home residents are able to eat and sleep on their own schedule, not according to the wishes of the staff.  Consistent assignment means that the same staff members are taking care of the residents everyday.  This promotes deeper and more engaging relationships between the staff and residents, and is also thought to decrease turnover.


Medicare only pays for medically necessary care in a nursing home (IVs, physical therapy).  It does not cover custodial care (bathing, eating, assisting).  Additionally Medicare only pays for the first 100 days in a skilled nursing home.  After that, Medicaid may pay for long-term programs, but there are many rules to qualify.

Medicaid provides benefits to those with low incomes, and may help pay for a nursing home.

Some pay privately with their own savings, and then use Medicaid when needed.  If you suspect this may happen, make sure the nursing home accepts Medicaid.

Another payment option is long-term care insurance, which is purchased privately and can pay for part of the nursing home cost.  The benefits vary.  (NIA).


An ombudsman is a federally funded advocate of nursing home residents.  They will be able to provide nursing home rankings in addition to those done by Medicare.  You can find your state ombudsman here.