No one can remember everything to ask, see, and do during a nursing home evaluation visit. Look over this checklist of questions and tips. Then print out this special version, designed to be brought and consulted as you ask questions and look around. It will make the process more efficient— and ease stress when it's hard to stay calm.
[See America's Best Nursing Homes and search for one near you.]
Questions to Ask
Who: a top administrator or the director of nursing
About special problems or needs. How would your home deal with my father's [dementia, difficulty maintaining weight, disability following stroke, or ____________________ ]?
About incontinence. How do you handle residents who are incontinent? Do you have them on a regular toileting schedule? If so, how often do staff members take them to the bathroom? Are many in diapers? Do you ever use catheters to manage resident incontinence?
About nutrition. What is your resident nutrition program? How do you identify residents who are losing weight? Do you regularly weigh them? What do you do to make sure residents are eating? How do you stimulate appetite in those who may have lost interest in food?
About falls. How often do residents fall here, and what do you do when that happens? What is your fall prevention program?
About health inspections. May I see your last survey inspection report? Do you have previous ones, and if so may I see those? How has your home remedied any problems that were identified?
About staff. What is your nurse and nurse aide turnover? What do you do to retain employees? How often do you use temp nurses from an agency? About how many families hire private nurses to supplement your staff nurses?
About worrisome or missing data. I saw a few things on "America's Best Nursing Homes" that concerned me [such as a high percentage of residents with moderate to severe pain; entries of NA—not available; other examples]. Could we talk about them?
Who: nursing staff
About the workload. How many residents do you care for? Is that too many or about right?
About employee morale. Do you feel as if this is a good place to work?
About the nursing staff. Does this nursing home have a lot of turnover among staff? Does it use a lot of temp nurses? Do some residents have their own private nurse whom their family hired from an outside agency?
Who: residents
About their care. Do you have friends? Are you kept busy? Does the home arrange outside activities for you? ["Are you happy here" won't yield much.]
About the nursing staff. Do you like the nurses and aides? Do you have the same ones most of the time, or do they change a lot? Do they help you to the bathroom, and if you need help, do you get it in time?
About nourishment. Do you ever need help eating? If so, is there enough staff to help you during meals? Are you often thirsty? Do you get enough to drink?
Who: members of other families
About the nursing staff. What are your loved one's medical concerns? Is the kind and amount of assistance she receives sufficient?
About falls. Has she ever had a fall here? What happened? Were you satisfied with how it was handled? How confident are you that it won't happen again?
About incontinence. Does she receive the help she needs to go to the restroom? Have you ever come to visit and found him sitting in his own waste?
About nutrition. Does your loved one need assistance eating? Does he get help? Does he have a good appetite? If not, does the nursing home do anything to help stimulate his interest in food?
About medications. How well do you think the staff here manages your loved one's prescriptions? Have there been medication-related problems? If he is drowsy, confused, or inattentive, do you believe he may be receiving too many drugs or the wrong ones—or too much of one or more drugs?
About quality of life. Does your loved one participate in activities? Are there options beyond bingo and movies? Do residents take excursions outside the home? Is your loved one dressed in her own clothes when you visit, or is she wearing a hospital gown?
What to Observe
About visitors. Is the parking lot full? Are grandchildren or family and friends around?
About resident engagement. Are many activities available or just bingo nights? Is the facility creative, regularly offering outings to museums or baseball games, art classes, or gardening on the grounds? Does it bring in volunteers to perform skits or music? Are there younger people or kids doing activities with residents?
About quality of life. Are residents dressed in hospital gowns or their own clothes? Are residents out of their rooms and doing things, or are they just lying in bed or gathered around a TV? Do they appear groggy or unaware of their surroundings, or are they actively engaged with one another and with staff?
About incontinence. Do you smell urine or strong antiseptic cleaners that may be covering up the smell?
About staff. Are staff members busy helping and talking with residents? Or are they unengaged, standing apart and talking among themselves? What tone does the staff use with residents? Are they addressed politely, by name? Are call lights on or blinking because residents need help in their rooms? Do the lights go out—meaning the person got the needed assistance—in a reasonable amount of time?
About nourishment. At mealtime, are residents who need help with eating getting assistance from a staff member? Or are trays placed in front of them—or set in their room—and picked up untouched? Is fresh drinking water readily available in the rooms and common areas?
About Saturday and Sunday. Staffing may be lighter on weekends, but do residents still have the help they need? Are weekend activities scheduled?
Click here to print out the special version for your nursing home evaluation visit.
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