America's Best Nursing Homes

No one looks forward to moving into a nursing home or putting a loved one there. But what to do when Dad is losing an alarming amount of weight because he lives alone and doesn't eat well, or when Mom's deepening depression and forgetfulness make her neglectful of vital medications? A nursing home may truly be the best option.

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With more than 15,000 nursing homes in the United States, even a modest-size city is likely to have 20 or more within a short drive. How can a manageable list be sifted out of so many possibilities? The guiding principle is to balance practical considerations, such as distance and expense, with issues of quality, such as results of health and fire safety inspections. You can readily obtain quality-related information by mining such resources as the new U.S. News "America's Best Nursing Homes" rankings, which rely on information collected, analyzed, and converted into ratings by the federal Centers for Medicare and Medicaid Service (CMS). Some states also post data online.

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• A Checklist for What to Ask and See

Once the universe of nursing homes has been whittled down to a few possibilities, it's time for an in-person assessment. No matter how diligent your research, data are only part of the story, and glossy brochures are an unknown mix of facts and marketing. You'll need to plan your tour in advance. Bring the U.S. News checklist to jog your memory. And be ready to use all of your senses, from sight to smell, to build a profile of each home. If time allows, visit more than once, ideally at different times of day and on different days of the week.

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You hope and pray the chosen nursing home is a good one. But the hard truth is that the first few weeks are bound to be difficult. And getting through them without trauma is no guarantee that the months and years ahead will be uneventful. You'll need to keep all of your powers of observation and diplomacy intact in order to monitor your loved one's care and be sure it remains as skilled and compassionate as possible. Here is time-tested advice from experts: expect an adjustment period, broaden your focus over the long term, check for special skills, be firm but don't yell, win over the staff, share your inside knowledge, ask staff about specific problems, and be alert for nursing home shifts.

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