By Nwanneka Uchechukwu, RN. Reviewed for general education; not a substitute for advice from your loved one’s doctor or care team.
Choosing a nursing home for someone you love is one of the hardest decisions a family can face. You are often making it quickly, during a hospital discharge or a health crisis, while worried and tired.
I have spent 15 years in patient care, 8 as a CNA and 7 as an RN, much of it in nursing homes. I have seen what good care looks like on an ordinary Tuesday afternoon, and I have seen what families miss when they only look at the lobby and the brochure.
This checklist is what I would want my own family to use. Take it with you, write in the margins, and do not feel shy about asking every question.
Before You Visit
Look up the facility first. A little homework tells you what to ask.
- Medicare’s Care Compare tool on Medicare.gov lets you search nursing homes and see star ratings for health inspections, staffing, and quality measures. Ratings are not the whole story, but they are a useful starting point.
- Read the most recent state inspection reports. Your state health department publishes them. Look for repeated problems, such as falls, pressure injuries, medication errors, or infection control, rather than a single issue.
- Contact your local Long-Term Care Ombudsman. Every state has this program. Ombudsmen are advocates for residents and often know a facility’s reputation well. They are free to contact.
Visit more than once if you can. Go once on a weekday during business hours, and again on an evening or weekend if possible. Staffing and atmosphere can look very different outside the daytime schedule.
What to Notice When You Walk In
The most useful information often comes from your own eyes, ears, and nose.
- How does it smell? Every facility has occasional odors, but a strong, lingering smell of urine can mean residents are not being toileted or changed promptly.
- How do staff treat residents? Watch whether they greet residents by name, make eye contact, and speak respectfully, including to residents who cannot respond.
- Do call lights get answered? Notice if lights stay on for a long time, or if you hear residents calling out with no one responding.
- How do the residents look? They should be clean, dressed, and well groomed, with hair combed and nails clean. Look for residents sitting alone in hallways with nothing to do.
- Is the atmosphere calm? Some noise is normal, but constant alarms, shouting, or chaos can point to understaffing.
- Do staff seem stressed or content? Turnover is a real concern in long-term care. Staff who seem rushed and unhappy are often a sign of deeper problems.
Questions About Staffing
Staffing is the single biggest factor in the quality of daily care. Ask directly.
- How many residents does each CNA care for on day, evening, and night shifts? Ask for numbers, not general answers.
- Is there a registered nurse in the building at all times? Ask who is in charge on nights and weekends.
- How long have the nurses and aides worked here? High turnover and heavy use of agency staff can mean inconsistent care, because staff who do not know your loved one may miss small changes.
- Will my loved one have consistent caregivers, or do assignments rotate?
Questions About Medical Care
- Which doctor or practitioner will oversee my loved one’s care, and how often are they in the building?
- How do you handle a change in condition? A good answer includes how quickly the nurse assesses, when the doctor is called, and when the family is notified.
- How do you prevent falls? Ask about bed and chair alarms, call light response, and how often residents are checked.
- How do you prevent pressure injuries (bedsores)? Ask about repositioning schedules, special mattresses, and skin checks.
- How are medications managed and reviewed? Residents often take many medications, and regular review for side effects and interactions matters.
- What happens in a medical emergency? Ask which hospital residents are usually sent to and how families are contacted.
Questions About Daily Life
Good care is not only medical. Quality of life matters just as much.
- Can I see a weekly activity calendar? Then ask whether activities actually happen and whether they suit your loved one’s abilities and interests.
- How are meals handled? Ask to see a menu, how special diets are managed, and whether residents get help eating. Weight loss and dehydration are common problems, and they can be missed if no one is watching closely.
- Can residents choose their own wake and sleep times, and when they bathe? A facility that respects routines tends to respect people.
- What are the visiting rules? Ask about hours, whether families can join meals, and what the policy is during outbreaks of illness.
If Your Loved One Has Dementia
- Is there a dedicated memory care unit? Ask how it is secured and how staff are trained in dementia care.
- How do you respond to agitation or confusion? Look for answers that focus on understanding the cause, such as pain, hunger, boredom, or fear, rather than relying first on medication or restraint.
- How do you handle wandering?
- Do residents have regular, meaningful activities suited to their stage of dementia, such as music, sensory activities, and gentle exercise?
Questions About Communication and Care Plans
- How and when will I be updated? Ask who your main contact is and how quickly the family is notified of falls, new symptoms, or medication changes.
- Can I attend care plan meetings? Families have the right to take part in planning care, and a good facility welcomes it.
- How are concerns and complaints handled? Ask to see the process. A facility that is comfortable with this question is usually one that listens.
Questions About Costs
- What exactly is included in the daily rate, and what costs extra? Ask about incontinence supplies, laundry, therapy, and personal items.
- What happens if my loved one’s care needs change or their payment source changes, for example from private pay to Medicaid?
- Can I get all of this in writing before signing an admission agreement? Read it carefully, and consider having an elder law attorney review it if you can.
Warning Signs to Take Seriously
No facility is perfect, but these deserve a second look:
- Staff who avoid your questions or will not let you see certain areas
- Residents who appear unclean, dehydrated, or left in bed all day
- Frequent mentions of staffing shortages
- Repeated serious issues in recent inspection reports
- A tour that feels rushed or carefully staged
- Your gut telling you something feels off. Trust it.
After the Tour
Sit down within a day and write down what you saw while it is fresh. Compare facilities on staff attitude, cleanliness, and how comfortable you felt asking hard questions, not only on how nice the building looks. Then, if you can, visit once more unannounced.
Choosing a facility is not a decision you have to make perfectly. It is one you can keep watching and adjusting. Once your loved one moves in, visit often and at different times, get to know the aides and nurses by name, and speak up early if something concerns you. Families who stay involved make a real difference in the quality of care their loved ones receive.
Have a question about long-term care that I haven’t covered? Contact me
Disclaimer: This article is for general educational purposes only and does not replace professional medical, legal, or financial advice. Talk with your loved one’s healthcare providers about their specific needs.