How to Choose a Nursing Home

Focus on location, care, quality of life, and cost.

iPad, Elderly, Aging, Senior, Comparing Nursing Homes

Once your family has considered all of the alternatives and has settled on a nursing home as the right decision for Mom or Granddad, choosing the right one starts with four general principles: The ideal home will be convenient to as many family members as possible. It will provide high-quality care if Mom has a chronic condition such as dementia or physical disability. It will offer Granddad welcoming, supportive environment. And its cost will fall within a range that a combination of savings, Medicare, Medicaid, and perhaps long-term care insurance can comfortably absorb.

[See U.S. News-rated nursing homes and search for one near you.]

The first step is to assemble potential candidates. Start with geography by searching your first choice of location at U.S. News's Best Nursing Homes, to generate a list of homes and see at a glance their ratings of one to five stars in three critical respects:

  • The kind and amount of nurse staffing the home provides;
  • The home's diligence in meeting state health and safety standards;
  • The home's performance in key medical and behavioral measures, such as the percentage of residents receiving annual flu shots and whether residents get sufficient help with daily activities.
  • After reviewing each home's pros and cons, by the end of your online session you should have a manageable number. You can then prune the list by visiting the homes, asking tough questions, and being attentive to each home's personality and attitude toward its residents. As you narrow the list, arrange repeat trips to those remaining, at different times and on different days of the week than when you first visited.

    [Read about Questions to Ask on a Nursing Home Visit, or download a checklist.]

    Your loved one's safety and health trump all other considerations. If you discover that a home's online evaluation included safety and health violations, you will want to ask administrators how they were handled. The mere fact of a violation need not rule out a home. It may have earned a lower rating because of a violation that was corrected quickly—such as a low-pressure fire extinguisher that was replaced within a day—or a violation could be serious and not so easily resolved, says Tom Burke, spokesman for the American Health Care Association (AHCA), a trade group that represents long-term care providers.

    Safety hazards aren't always obvious. For example, you should look for frayed carpets and other potential causes of a fall, says Barbara Glickstein, a registered nurse and co-director of the Center for Health, Media & Policy at Hunter College in New York City.

    Adequate staffing is critical to a safe and healthy environment. Without enough nurses and aides, care suffers. A resident with shaky hands who doesn't get the help she needs at meals can become malnourished. An infirm resident who has to wait to get help with toileting can develop a urinary tract infection that could progress to a life-threatening blood infection or kidney failure. Staffing ratios displayed on Best Nursing Homes indicate the time nurses at different levels spend with patients on average.

    One potentially valuable figure that you won't see would show staff turnover. Heavy turnover is an obvious indication of unhappy workers, whose dissatisfaction could mean worse care. The national average for turnover in 2010 was 39.5 percent for all positions within a nursing home, according to an AHCA report published last year. The federal government has plans in the works to collect and report the information but does not now require homes to show it.

    Burke recommends focusing on "consistent assignment," meaning whether nurses and aides care for the same residents on most of their shifts. If residents can see the same caregivers most of the time, they can build relationships and will feel more comfortable and secure. AHCA recommends that individual staffers care for the same residents on at least 80 percent of their shifts. You should ask administrators whether their caregivers work with the same residents. Ask residents and their families, too.