How to Choose a Nursing Home

Choosing a nursing home can involve urgent medical, financial, and emotional decisions. A hospital may be preparing for discharge. A family caregiver may no longer be able to provide safe care. A person may need rehabilitation, 24-hour nursing, or extensive help with daily activities.

There is no single “best” nursing home for everyone. The right choice depends on the resident's needs, preferences, location, payment source, available beds, and the facility's ability to provide safe and respectful care.

Medicare Care Compare is an important starting point, but ratings should be combined with inspection reports, staffing information, visits, interviews, contracts, and professional guidance.

Before deciding: Confirm whether the need is short-term skilled rehabilitation or long-term custodial care. Medicare coverage differs, and Medicare generally does not cover long-term nursing home stays except for covered skilled care under specific conditions.

What nursing homes provide

Nursing homes generally provide:

• 24-hour nursing
• Help with bathing, dressing, eating, toileting, and mobility
• Medication administration
• Meals
• Care planning
• Social services
• Activities
• Rehabilitation services
• Access to medical care

Some specialize in:

• Short-term rehabilitation
• Dementia care
• Ventilator care
• Wound care
• Bariatric care
• Behavioral health
• Complex medical needs

Confirm the facility can meet the person's actual needs, not merely that it advertises a service.

Step 1: Define the care needs

Ask the hospital, physician, nurse, therapist, or care manager:

• What level of care is needed?
• Is rehabilitation expected?
• What equipment is required?
• Is skilled nursing needed?
• Are there wound, respiratory, dialysis, behavioral, or dementia needs?
• Can the person transfer safely?
• What medications and monitoring are required?
• How long might care be needed?
• What would make discharge home safe?
• What facilities are clinically appropriate?

A facility may decline admission if it cannot safely meet the needs.

Step 2: Understand short-term and long-term care

Short-term skilled care

A person may enter a skilled nursing facility after hospitalization for rehabilitation or nursing services. Medicare may cover qualifying skilled care for a limited period when requirements are met.

Long-term care

Long-term nursing home care often includes ongoing help with personal needs. Medicare generally does not cover long-term custodial care.

Payment may involve:

• Personal funds
• Medicaid, if eligible
• Long-term care insurance
• Veterans' benefits
• Other programs

Ask for written information about coverage and personal responsibility.

Step 3: Build a realistic search area

Location affects:

• Family visits
• Access to preferred physicians
• Transportation
• Cultural and language needs
• Hospital relationships
• Community ties

A nearby facility may make frequent visits easier, but proximity should not override serious quality or care concerns.

Step 4: Use Medicare Care Compare

Medicare Care Compare provides information on Medicare- and Medicaid-certified nursing homes.

The overall star rating combines:

• Health inspections
• Staffing
• Quality measures

What ratings can do

They can help:

• Identify differences
• Review recent inspections
• Compare staffing
• Find abuse citations
• Create a visit list

What ratings cannot do

They do not show:

• Whether a bed is available
• Whether the facility accepts a particular person
• Current staff behavior on every unit
• Roommate compatibility
• Food preferences
• Communication quality
• How well the facility meets a specific need
• Every recent change

Read the underlying categories rather than relying only on the overall number.

Step 5: Review inspections and enforcement

Look for:

• Repeated deficiencies
• Serious harm findings
• Abuse citations
• Infection-control problems
• Medication problems
• Delayed care
• Inadequate supervision
• Failure to follow care plans
• Fire-safety issues
• Whether deficiencies were corrected

One citation does not tell the entire story, but repeated or serious problems deserve detailed questions.

Ask the facility for the latest inspection report. Nursing homes must make recent survey information available.

Step 6: Examine staffing

Staffing affects response time, supervision, personal care, and continuity.

Review:

• Registered nurse hours
• Licensed practical nurse hours
• Nursing assistant hours
• Weekend staffing
• Staff turnover
• Agency staff use
• Administrator and director-of-nursing turnover
• Specialized training
• How staffing changes when residents need more help

Ask:

• Who is responsible on each shift?
• How quickly are call lights answered?
• How are absences covered?
• How many residents is each aide assigned?
• Is an RN onsite as required?
• Who contacts the family after a change?

Staffing numbers are important, but observe how staff and residents interact.

Step 7: Visit—more than once if possible

Visit during different times:

• Weekday
• Evening
• Weekend
• Mealtime
• Activity time

A scheduled tour may show the facility at its best. An additional visit can reveal consistency.

Observe the environment

• Is the building clean?
• Are odors overwhelming?
• Is lighting adequate?
• Are halls uncluttered?
• Is the temperature comfortable?
• Are residents dressed appropriately?
• Are call lights sounding for long periods?
• Is drinking water available?
• Are mobility devices within reach?
• Are doors and outdoor areas secure without being unnecessarily restrictive?

Observe interactions

• Do staff knock before entering?
• Are residents addressed respectfully?
• Do staff explain what they are doing?
• Are residents rushed?
• Are requests acknowledged?
• Do staff appear familiar with residents?
• Are people left isolated without explanation?
• Are residents encouraged to make choices?

Respectful care matters as much as an attractive lobby.

Step 8: Review rooms and daily life

Ask about:

• Private and shared rooms
• Roommate selection and changes
• Personal furniture
• Storage
• Phone and internet
• Visiting
• Outdoor access
• Religious and cultural support
• Pets
• Smoking rules
• Laundry
• Transportation
• Salon or barber services
• Activities
• Quiet hours
• Leaving for visits

For a shared room, consider privacy, sleep, noise, and compatibility.

Step 9: Evaluate meals and nutrition

Ask:

• Is a dietitian involved?
• Are menus available?
• Are cultural and religious preferences accommodated?
• How are allergies handled?
• What happens when a resident dislikes a meal?
• Is assistance available?
• Are snacks offered?
• How is weight loss addressed?
• Can family join meals?

Observe an actual meal if possible.

Step 10: Ask about medical care

• Who is the medical director?
• Can the resident keep a personal physician?
• How are nurse practitioners involved?
• How are specialists arranged?
• Which hospitals are used?
• How are emergencies handled?
• How are lab and imaging services provided?
• How are medication changes communicated?
• How are dental, hearing, vision, and mental-health needs addressed?
• Is telehealth used?

For rehabilitation:

• How often is therapy provided?
• Is therapy individual or group?
• What goals are used?
• How is progress communicated?
• What happens when coverage ends?

Step 11: Ask about dementia support

If dementia care is needed:

• What staff training is required?
• Is the unit secured?
• How is wandering managed?
• How are distress and behavioral changes addressed?
• Are non-drug approaches used first when appropriate?
• How are families involved?
• What needs would require transfer?
• How is hospital use reduced?
• Are activities adapted?

A locked unit or “memory care” label does not guarantee appropriate staffing or care.

Step 12: Understand safety and abuse prevention

Ask:

• How are staff screened?
• How are allegations reported?
• How are residents protected from abuse by staff or other residents?
• What is the grievance process?
• How can someone contact the state survey agency?
• Is ombudsman information displayed?
• Has the facility been cited for abuse?
• How are falls investigated?
• How are restraints avoided?
• How are missing residents handled?

Residents have rights, including the right to dignity, privacy, participation in care, and freedom from abuse.

Step 13: Review the contract and costs

Request a written breakdown of:

• Daily or monthly rate
• Therapy
• Medical supplies
• Transportation
• Private room
• Laundry
• Personal care items
• Salon
• Phone and internet
• Pharmacy
• Deposits
• Bed-hold policy
• Rate changes
• Discharge and transfer rules
• Medicaid conversion policy

Do not sign documents you do not understand. Legal advice may be appropriate for complex admissions agreements.

Be cautious about requests for a family member to become personally responsible for payment. Federal and state rules may limit what facilities can require, but legal interpretation depends on the situation.

Step 14: Contact the Long-Term Care Ombudsman

The Long-Term Care Ombudsman program advocates for residents of nursing homes and other long-term care settings.

An ombudsman may help with:

• Resident rights
• Complaints
• Facility information
• Care concerns
• Discharge issues
• Communication problems

The Eldercare Locator can connect people with the local program.

Step 15: Talk with residents and families

When appropriate, ask:

• Are staff responsive?
• Is the food acceptable?
• Are activities meaningful?
• Are concerns addressed?
• Is communication reliable?
• What happens on weekends?
• Is personal property secure?
• Would they choose the facility again?

Respect privacy and do not pressure residents to discuss personal care.

Red flags

Pause when you encounter:

• Refusal to show inspection reports
• Pressure to sign immediately
• Unexplained fees
• Strong odor or poor hygiene
• Residents calling for help without response
• Staff speaking disrespectfully
• Frequent unanswered phones
• Inability to explain staffing
• Missing medication information
• Repeated serious citations
• High leadership turnover without explanation
• Restrictions on reasonable visits
• No clear complaint process
• Promises that sound medically unrealistic
• Contract terms that are not explained

A single observation should be investigated rather than automatically treated as proof, but patterns matter.

Admission-day checklist

Bring or confirm:

• Identification
• Insurance information
• Medication list
• Prescriptions
• Allergies
• Physician orders
• Advance directive
• Healthcare proxy
• Emergency contacts
• Clothing
• Mobility equipment
• Hearing aids and glasses
• Personal items
• Preferred routines
• Communication needs
• Cultural and dietary preferences

Label personal property and keep an inventory.

After admission

Continue monitoring:

• Care plan
• Weight
• Skin
• Falls
• Medication
• Therapy
• Mood
• Activities
• Communication
• Billing
• Roommate issues
• Personal property

Attend care-plan meetings. Ask for explanations when care changes.

Frequently asked questions

Is a five-star nursing home always the best choice?

No. Ratings are useful but do not replace assessment of specific needs, current staffing, visits, and availability.

Does Medicare pay for nursing-home care?

Medicare may cover qualifying short-term skilled care, but it generally does not cover long-term custodial stays.

Should I choose the closest facility?

Location matters, but it should be balanced against care quality, staffing, specialization, and the resident's preferences.

What is an ombudsman?

A Long-Term Care Ombudsman advocates for residents and helps address complaints and rights issues.

Can a nursing home discharge a resident?

Facilities must follow applicable rules. Seek prompt help from the ombudsman, state agency, legal aid, or an attorney when a discharge is disputed.

Where can I compare facilities?

Use Medicare Care Compare for certified nursing homes and review state licensing and inspection information.

Suggested internal links

• /nursing-homes
• /resources/different-options-for-senior-care
• /resources/the-best-advice-for-planning-to-meet-your-need-for-long-term-care

Sources

• Medicare Care Compare — Nursing Homes
• Medicare — Overall Star Rating for Nursing Homes
• Medicare — Your Guide to Choosing a Nursing Home
• Medicare — Questions to Ask When You Visit a Nursing Home
• Medicare — Nursing Home Care
• Eldercare Locator

This article provides general information and does not replace medical, legal, financial, insurance, benefits, licensing, or placement advice.