The decision to place a loved one or to move into a nursing home can be a difficult one. Finding a suitable and comfortable facility can be even more difficult. You want your loved one to be happy there, but what information do you need to make your decision?

The following nursing home checklists are to help you gauge the residence, and what they provide so you can make an informed decision. Take the lists with you so you can start the discussion with the facility manager, and so you don’t forget to ask anything. Sometimes when faced with a difficult decision, your mind will go blank if they say “any questions?” Some of the questions are for you to answer yourself during a tour and others are questions you’ll need to ask the facility manager.

Don’t be afraid to ask a lot of questions, and take all of them into account when you make your decision.

First Impression

Your first impression of a place can tell you a lot about the facility and how your loved one might feel living there. Take stock of how you feel when you walk in, what the current residents are doing and how they look. Does it seem like a positive environment? How is the staff treating the residents?

• Do you like the facility’s location and outward appearance?
• Is the facility convenient for frequent visits by family and friends?
• Are you welcomed with a warm greeting from the staff?
• Does the staff address residents by their names and interact with them during your tour?
• Do you notice the residents socializing with each other and do they appear content?
• Is the staff appropriately dressed, friendly, and outgoing?
• Do the staff members treat each other professionally?
• Are visits with the residents encouraged and welcome at any time?
• What percentage of the rooms/beds are available?
• Is there a waiting list? If so, how long do they estimate it will take to get admitted?

Living Area and Accommodations

The living area is one of the most critical aspects of the facility, obviously. It’s likely where your loved one will spend the most time. Take stock of what it looks like and ask if they’re able to decorate themselves or bring in their own furniture to make it more like a home.

Be sure to note if the overall design is conducive to elderly residents and their needs. Will it be easy for them to move around in a wheelchair or walker?

• Is the floor plan well designed and easy to follow?
• Are doorways, hallways, and rooms accommodating to wheelchairs and walkers?
• Are elevators available for those unable to use stairways and handrails to aid in walking?
• Are floors of a non-skid material and carpets conducive for safe walking?
• Does the residence have good lighting, sprinklers, and clearly marked exits?
• Is the residence clean, free of odors, and appropriately heated and cooled?
• What is the facility’s means of security if a resident wanders?
• Are the common areas, in general, attractive, comfortable, and clean?
• Is there an outside courtyard or patio for residents and visitors, and assistance getting there?
• Does the residence provide sufficient security and is there an emergency evacuation plan?
• Are private rooms available and/or double occupancy units for sharing with another person?
• Does the residence have furnished or unfurnished rooms? What is provided or what can they bring?
• May they decorate their own rooms? Is there adequate storage space?
• Is a 24-hour emergency response system accessible from the unit?
• Are bathrooms private with handicapped accommodations for wheelchairs and walkers?
• Do all units have a telephone and cable TV? How is billing handled?

Moving In, Contracts, and Finances

Conversations about money and contracts can be difficult to begin, but the information you receive from them will be an essential aspect of your decision. The following nursing home checklist will help you start the conversation and find out more about how the facility is run and what they expect from you.

• What’s involved with the moving in/out process? How is the initial needs assessment done?
• Does the assessment process include the resident, family, facility staff, along with the physician?
• Is there an ongoing written plan for the care of each resident? Is there an ongoing process for assessing a resident’s need for services and how often are those needs evaluated? Is there a written statement available of resident rights and responsibilities?
• Is a contractual agreement available that clearly discloses healthcare, accommodations, personal care and supportive services, all fees, and admission and discharge provisions?
• What type of insurance is required/accepted? Medicare, Medicaid, long-term care, or private?
• What are the specific costs for various levels of care including skilled and unskilled beds?
• What additional services and staff are available if the resident’s needs change?
• When may a contract be terminated and what are the policies for refunds and transfers? Is there an appeals process for dissatisfied residents?
• What happens if funds are depleted, and full payments can no longer be made?
• Is there any government, private, or corporate programs available to help cover the costs?
• Is there a procedure to pay for additional services such as skilled nursing care when the services are needed on a temporary basis?
• Do billing, payment, and credit policies seem fair and reasonable? May the resident handle their own finances with staff assistance if able? Does a family member/third party need to be designated?

Health/Personal Care/Services

Perhaps the most significant reason you want to move into a nursing home is the personal care services that you can’t get in your own home. Find out what kind of services are available to residents and if any of them are included in the price. The personal care services will play a huge role in your decision-making process, so be sure to get all of the information you can.

• What type of healthcare and personal care services are available? Does the facility have both short and long-term services, such as routine physical, dental, and vision examinations as well as skilled nursing?
• Can the facility provide a list of available services and are residents and families involved in developing the care plan/service agreement? Who provides these services and what are their qualifications?
• Are physical, occupational, or speech therapy services available onsite? Who coordinates these services and how are they billed to Medicare, Medicaid, or other third-party insurance?
• Is staff available to provide 24-hour assistance with activities of daily living (ADLs) if needed? ADLs include dressing, eating, mobility, hygiene, grooming (bathing, toileting, incontinence).
• Does the residence have Alzheimer’s programs or other dementias and other specialized areas? How does staff safely manage residents who might wander?
• Is staff available to assist residents who experience memory, orientation, or judgment losses?
• How are medical emergencies handled? Does the residence have a clearly stated procedure for responding to medical emergencies? Is there an arrangement with a nearby hospital?
• Are housekeeping, linen service, and personal laundry included in the fees or are they extra charges?
• Does the residence provide transportation to doctors’ offices, the hairdresser, shopping, and other activities desired by residents? Can it be arranged on short notice?
• Are pharmacy barber/beautician and physical therapy services offered on site?
• How does staff safely administer, monitor, and assist a resident in taking medicine?
• Does the residence pharmacy provide delivery, consultation, and review of medicines?
• Does a staff physician visit the residence regularly for medical checkups or can the resident have their own personal physician?

Social and Recreational

One of the biggest worries about moving your loved one into a nursing home is that they won’t make friends or enjoy their time there. Find out if there are social and recreational activities both in the facility and in the broader community. Do they sound like activities that your loved one will enjoy?

• What kinds of group or individual recreational activities are offered and who schedules them?
• Is there an organized activities program with a posted daily schedule of events?
• Do volunteers and family members come into the residence to participate or conduct programs?
• Does the facility schedule trips or go to other events off premises?
• Do residents participate in activities outside of the residence in the neighboring community?
• Are the resident activity (social) areas appropriate and desirable to the prospective resident?
• Are there supplies for social activities/hobbies (games, cards, crafts, computers, gardening)?
• Are religious services held on the premises or arrangements made for nearby services?
• Are there fitness facilities, as well as regularly scheduled exercise classes?
• Does the residence create a sense of community by allowing residents to participate in specific activities or perform simple chores for the group as a whole?
• Does the facility have pets? Who is responsible for their care?

Staff

The reason you’re moving a loved one into a nursing home is probably that they require assistance from trained staff. If there’s a lot of staff turnover, that can create a level of chaos your loved one may find uncomfortable. Find out the ratio of nursing staff to resident, so you know how many residents any given staff member is responsible for, and if that number seems manageable.

• Are nursing staff members courteous and friendly to residents and to other staff?
• Do nursing staff respond timely to resident’s requests for assistance such as help getting in and out of bed, dressing, and going to the bathroom?
• Which nursing staff members are involved in planning the resident’s individual care? Are they the same ones who give the care to the residents?
• Ask questions about staff turnover. Is there frequent turnover among certified nursing assistants (CNAs)? What about turnover for nurses and supervisors, including the Director of Nursing and the Administrator?
• What is the nursing staff to resident ratio? How many registered nurses (RNs) and Licensed Practical Nurses (LPNs) are on staff? How many per shift? What are their training and education?
• What is the nursing assistant to resident ratio, and how many are on staff? How many on each shift? What kind of training do CNAs receive?
• What is the history of compliance with staffing ratios? Are there incentives to help with staffing?
• How does the nursing home ensure that all staff maintains licensure or certification, receives continuing education, and keeps their knowledge and skills up-to-date?

Food

Does the facility provide meals and is the menu varied from day to day? Tasty, healthy food can make a difference in how happy your loved one will be at the facility and how healthy they are during that time. Don’t be afraid to ask tough questions about the food service, because it’s crucial to find out before you make your decision.

• Does the residence provide three nutritionally balanced meals a day, seven days a week, and how does the menu vary from meal to meal?
• Observe meal times. Do all residents who need assistance with eating get help? Does the staff give each resident enough time to chew food thoroughly and complete the meal?
• What about special diets? Does a dietitian plan or approve menus? Are residents’ weight routinely monitored?
• Are residents involved in menu planning? Can they request special foods? Are snacks available?
• Does the dining room environment encourage residents to relax, socialize, and enjoy their food?
• Are water pitchers and glasses accessible in rooms and does staff assist with drinking as needed?
• Are common dining areas available? Is tray service available when will and staff to assist?
• May meals be provided at a time a resident would like or are there set times for meals?
• May residents have guests for meals in the dining room for an additional fee? Is there a private dining room for special events and occasions?

Licensure and Certification

Information about how well the facility is run will give you a look into the way your loved one will be treated during their time there. If it seems like a chaotic facility with a lot of turnover and difficulty keeping their certification, you probably want to find a different place.

• Is the facility Medicare or Medicaid certified?
• Is this a skilled nursing facility and is a skilled bed available?
• Is the facility accepting new patients? Is there a waiting period for admission?
• If the facility is sponsored by a nonprofit organization and managed under contract with a commercial firm, what are the conditions of that contract?
• Is there a resident council or organization through which residents and family have a means of voicing their views on the management of the community?
• Each state requires the residence to be licensed and/or certified. Does the facility have a current license or certification? Is it displayed?
• Each state requires the administrator to be licensed and/or certified. Do they have a current license or certification?
• What reputation does the facility have in the community? How long has it been in business? Is it in good financial health? Does the facility follow generally accepted accounting procedures?
• Has the facility corrected any quality of care deficiencies in their State inspection report?

There’s a lot to think about when you’re looking for the right nursing home for your loved one. Our nursing home checklists are designed to help you ask the right questions at the right time so you can make the best decision possible. Don’t be afraid of asking a lot of questions and then even more follow-up questions. The facility managers should be prepared to answer every single one of these questions and then some. If they aren’t, find a facility that can.