Whether you’re in the process of selecting a nursing home for yourself or a loved one, due diligence is key, as the decision is a big one, notes Sheri LaBree, a geriatric social worker and operations manager at Care.com.
“For many people, this is where they’ll spend the rest of their lives,” says LaBree. “We all want the best care for the people we care about, so starting your research ahead of time whenever possible will help you to understand the options in your community.”
From how to completely begin your search to what to look for on all of your tours, here’s how to choose a nursing home, according to experts.
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Sheri LaBree, geriatric social worker
“We all want the best care for the people we care about, so starting your research ahead of time whenever possible will help you to understand the options in your community.”
Why research is key when selecting a nursing home
When it comes to nursing homes, one size does not fit all. “There are some good, high-quality nursing homes out there,” LaBree says, “but unfortunately, there are quite a few with serious quality problems.”
“If you want to make sure your loved one is cared for, you need to go the extra mile when narrowing down your choices and ultimately selecting a nursing home,” notes Marilyn Gugliucci, professor and the director for Geriatrics Education and Research at University of New England in Portland, Maine.
Put another way: By putting in work on the front end, you won’t find yourself or your loved one in an unpleasant or uncomfortable living situation in the future.
“If you want to make sure your loved one is cared for, you need to go the extra mile when narrowing down your choices and ultimately selecting a nursing home.”
— Marilyn Gugliucci, professor and the director for geriatrics education and research
Selecting a nursing home: where to begin
Before you even begin looking at nursing homes, figure out where the person entering the nursing home wants to live geographically.
“It’s important to determine with the older adult (if they have good cognition) which state they’re going to live in and how close they want their home to be to where their family lives,” notes Gugliucci. “It’s possible that the older adult wants to stay in their current state, which may not be the state where the family is.”
From there, both she and LaBree recommend starting the search on Medicare.gov; more specifically, they suggest using their Nursing Home Compare (NHC) tool.
“The NHC uses a 5-star rating system to rate nursing homes on a variety of different factors, which is based on inspection reports from unannounced visits to the nursing home,” explains LaBree, who adds that the most important things to look at are the overall rating and the health inspections rating.
“The higher the stars, the better,” she continues. “The NHC will also show you if a nursing home has been cited for a pattern of severe problems (look for a yellow triangle warning) or if they have a pattern of abuse of residents (look for a red circle with a hand). You should absolutely steer clear of these buildings.”
Gugliucci also recommends looking to see if a home has a CARF (Commission on Accreditation of Rehabilitation Facilities) rating of 4 or higher, which is “excellent.”
“CARF is a private, not-for-profit organization that accredits health and human service providers, including nursing homes,” she explains. “There are other types of nursing home ratings, but CARF is the gold standard.”
Finally, Gugliucci suggests setting your sights on nonprofit nursing homes, as opposed to for-profit options.
“In nonprofit homes, the funding goes back into the care and infrastructure of the home,” she explains. “For a for-profit home, the funds can go into the pockets of the owners for the home. In for-profits, one has to be extremely diligent to understand where the money goes and how it supports the residents.”
How to evaluate a nursing home after you’ve narrowed down your list
After you’ve decided which nursing homes have made the list, it’s time to arrange a tour. “Meet with both the CEO and the admissions coordinator for the nursing home on or before your tour,” Gugliucci says. “The CEO should be amenable to meeting the family — if not, find another home.”
Another thing you can do, per LaBree, is contact your local ombudsman, who is an impartial advocate for nursing home residents. “While they can’t recommend a nursing home toward you,” she says, “they may be able to steer you in the right direction.”
What to look for on your nursing home tour
In addition to being armed with questions to ask on your nursing home tour, here’s what else to do, per LaBree and Gugliucci:
- Tour the entire facility.
- Meet the CEO, the leadership team, activities staff, etc.
- Give your phone number to the staff and ask them to provide it to a family of a current resident who is comfortable reaching out to you.
- Look for cleanliness and strong smells.
- Look to see that everything is in good repair.
- Get a feel for the culture of the home. “Don’t be fooled by homes that simply look wonderful,” notes Gugliucci.
- Pay attention to how the staff is interacting with the residents.
- Notice if the residents are engaged in activities.
- Notice if the residents appear clean and well-groomed.
- Look for amenities you’re interested in, such as a barber shop, rehab gym, etc.
- Ask to look at the nursing home inspection reports (they are required to make the past three years available for anyone to review).
- Look at their staffing ratios for the day — a lower staff-to-patient ratio is best.
“If you are trying to find a place for a family member with dementia, it’s also important to find out if the nursing home has a dedicated dementia unit,” LaBree adds. “It’s best if the dementia unit is secured, and it’s ideal if it has its own activities and nursing staff.”
How to choose a nursing home
You’ve researched, you’ve toured, now it’s time to make your choice — but how? One way, Gugliucci notes, is by employing the the 4 Ms of Age-Friendly Healthcare:
Matters Most. Does the older person really want to move to this nursing home or would they rather move in with a family member or bring in home care and stay in their own home? “These points should be talked about even before the search for a nursing home begins,” Gugliucci says.
Medications. Check on the data for medication management of the residents of the home you’re considering. “The home is required to report how many errors they’ve made in medication management,” she says. “This is important, as incorrect distribution of meds can cause serious harm.”
Mentation or cognition. Gugliucci says to get a feel of how the staff is for people with dementia. How are they being honored? How are they given some independence? Is there a safe outdoor space? What kind of activities are available? Is there music in the home or does everyone have their TVs on and stay in their rooms?
Mobilization. Are there exercise programs, physical therapy (PT) and occupational therapy (OT) services? What kinds of outings does the home offer? Do you get the sense the staff want their residents engaged or prefer to have them sedated and in their rooms? Are there flexible mealtimes? How close does the home support what the older person does currently in their own home?
In addition to considering the 4 Ms, it’s important to go with your gut based on what you see on the tours. “As someone who has had to place my mom into one at the end of her life, I leaned heavily on what I learned on Medicare.gov,” says LaBree. “But I also toured nursing homes and asked questions until I felt comfortable with the answers. I paid close attention to what I noticed on the tour, especially how I saw staff interacting with residents.”
After you’ve made your choice
Your work isn’t done once you’ve made your choice and signed a contract. Be sure to visit with older loved ones often, notes LaBree, and each time, chat with the staff.
“Help them get to know your loved one — who they are and what is unique about them,” she says. “These relationships can make a big difference with the quality of care your family member receives.”
