Quick Answer
To choose a nursing home: (1) Check Medicare star ratings and inspection reports online, (2) Visit at least 3 facilities in person, (3) Verify they accept your insurance/Medicaid, (4) Talk to staff and residents, (5) Trust your instincts about cleanliness, safety, and culture. Use our free search tool to compare facilities near you.
Table of Contents
Understanding Your Options
Before diving into nursing home selection, it's important to understand whether a nursing home is the right level of care for your loved one. Many families explore nursing homes when they're actually looking for assisted living or memory care.
Types of Senior Care Facilities
Nursing Homes (Skilled Nursing Facilities)
Best for: 24/7 medical care, post-surgery rehabilitation, advanced dementia, chronic illness requiring nursing supervision. Medicare typically covers first 100 days for post-hospital care. Medicaid covers long-term stays for those who qualify.
Assisted Living Facilities
Best for: Help with daily activities (bathing, dressing, medication management) but don't need constant medical care. Typically not covered by Medicare/Medicaid. Average cost: $4,500/month.
Memory Care Units
Best for: Alzheimer's or dementia requiring specialized, secured environment. Can be standalone or within nursing homes/assisted living. Focus on safety, routine, and specialized activities.
Home Health Care
Best for: Seniors who want to stay home but need part-time nursing or therapy. Medicare covers home health if medically necessary. Services include nursing visits, physical therapy, and personal care aides.
This guide focuses on nursing homes (also called skilled nursing facilities or SNFs). If your loved one needs 24-hour medical supervision, help with most daily activities, or is being discharged from a hospital, a nursing home is likely the appropriate choice.
How to Read Medicare Star Ratings
Medicare's 5-star rating system is your first and most important tool for evaluating nursing homes. Every Medicare/Medicaid-certified nursing home in the U.S. is rated on three key measures:
Health Inspections (Most Important)
Based on annual on-site surveys by state inspectors. They check resident care, safety, cleanliness, staff competence, and compliance with regulations.
Staffing Levels
Measures the number of nursing staff hours per resident per day. Higher staffing = better care. Looks at both total nursing hours and specifically Registered Nurse (RN) hours.
Quality Measures
Clinical outcomes like how often residents experience pressure ulcers, falls, infections, or unnecessary use of antipsychotic medications.
How to Interpret Star Ratings
- ⭐⭐⭐⭐⭐ 5 stars (Excellent): Well above average in all categories. Your top choices.
- ⭐⭐⭐⭐ 4 stars (Above Average): Good quality care with few concerns.
- ⭐⭐⭐ 3 stars (Average): Meets minimum standards but may have some issues.
- ⭐⭐ 2 stars (Below Average): Multiple deficiencies or concerns. Tour carefully.
- ⭐ 1 star (Poor): Serious quality concerns. Avoid unless dramatically improved since last inspection.
Pro tip: Don't just look at the overall star rating. Click through to see the health inspection rating specifically. A facility might have 3 stars overall but only 1-2 stars for health inspections—that's a red flag. Use our search tool to filter facilities by star ratings and compare quality metrics side-by-side.
What to Look For in a Nursing Home
Beyond star ratings, there are five critical areas to evaluate when choosing a nursing home. Prioritize these during your research and tours:
🏥 Quality of Care
- ✓Medicare ratings: 4-5 stars for health inspections
- ✓Inspection reports: No recent serious violations (abuse, neglect, safety hazards)
- ✓Medical director: On-site regularly, not just "on call"
- ✓Specialized care: If needed (wound care, dialysis, ventilator, dementia care)
- ✓Partnerships: Relationships with nearby hospitals for emergencies
👥 Staffing Levels & Stability
- ✓Staffing ratio: At least 1 nurse per 6-8 residents during day shift
- ✓RN presence: Registered Nurse on duty 24/7, not just LPNs or CNAs
- ✓Staff turnover: Low turnover (ask during tour—high turnover disrupts care continuity)
- ✓Staff demeanor: Observe interactions—are they patient, compassionate, engaged?
- ✓Language match: Staff who speak your loved one's primary language
✨ Safety & Cleanliness
- ✓Odor-free: Should not smell of urine, feces, or strong cleaning chemicals
- ✓Well-lit: Bright common areas and hallways (reduces falls)
- ✓Fall prevention: Grab bars, non-slip floors, call buttons within reach
- ✓Infection control: Hand sanitizer stations, staff following hygiene protocols
- ✓Security: Secured exits (for dementia units), visitor sign-in, monitored entrances
- ✓Resident rooms: Clean linens, personal belongings respected, no clutter
🌟 Resident Quality of Life
- ✓Activities: Daily calendar of meaningful activities (not just bingo and TV)
- ✓Meals: Good food quality, choices offered, dietary needs accommodated
- ✓Outdoor access: Safe outdoor space for residents to enjoy fresh air
- ✓Social engagement: Residents interacting with each other, not isolated in rooms
- ✓Personalization: Residents can bring furniture, photos, decorations
- ✓Resident council: Residents have a voice in facility decisions
📍 Location & Practical Considerations
- ✓Distance: Close enough for regular family visits (research shows frequent visits improve outcomes)
- ✓Insurance/Medicaid: Accepts your payment method and has available beds
- ✓Costs: Clear pricing, no hidden fees, understand what's included vs extra charges
- ✓Availability: Bed available when needed (or short waitlist)
- ✓Visiting hours: Flexible hours, no unnecessary restrictions
Ready to Start Your Search?
Use our free navigator to find nursing homes near you that match your needs, insurance, and preferences. Compare Medicare ratings, staffing data, and quality measures for facilities in your area.
Start Free Facility Search →Essential Questions to Ask During Tours
Touring facilities in person is non-negotiable. No amount of online research can replace seeing the environment, meeting staff, and observing resident care firsthand. Here are the must-ask questions organized by category:
Staffing Questions
- What is your current staffing ratio (residents per nurse)?
- Is an RN on duty 24/7, or just during certain shifts?
- What is your staff turnover rate?
- How do you handle staff shortages or call-outs?
- Do staff receive ongoing training? (Dementia care, fall prevention, etc.)
- Can I meet the nurse who would be assigned to my loved one?
Medical Care Questions
- How often does a doctor visit residents?
- Can my loved one keep their current doctor?
- How do you handle medical emergencies? (On-site response time? Hospital transfers?)
- What specialized services do you offer? (Physical therapy, wound care, etc.)
- How do you manage medications and pharmacy services?
- Do you have isolation rooms for infection control?
Daily Life Questions
- What does a typical day look like for residents?
- What activities are offered daily? Who leads them?
- Can I see this week's meal menu? Can residents make food requests?
- How do you accommodate dietary restrictions or cultural food preferences?
- Is there outdoor space residents can access?
- Can residents bring personal furniture or decorations?
- How do you help residents maintain connections with family and community?
Communication & Family Involvement
- How often will you update me about my loved one's condition?
- How do you communicate changes in health status? (Phone? Portal? In-person?)
- Can family participate in care planning meetings?
- Are there any restrictions on visiting hours?
- Is there a family council or support group?
- How do you handle complaints or concerns?
Financial & Administrative Questions
- What is the daily/monthly rate? What's included?
- What services cost extra? (Laundry, salon, special therapies)
- Do you accept Medicare/Medicaid? Are beds available?
- What happens if my loved one runs out of money?
- What is your discharge policy? (Under what circumstances would a resident be asked to leave?)
- Can I review the contract before signing? Is there a trial period?
Pro tip: Visit at different times of day, including during a meal. Observe how staff interact with residents when they don't know they're being watched. The best facilities won't rush your questions and will offer to introduce you to current residents and families.
Red Flags to Avoid
Trust your instincts. If something feels "off" during a tour, it probably is. Here are serious warning signs that should make you cross a facility off your list:
🚨 Immediate Disqualifiers
- • Strong odors (urine, feces, body odor)
- • Residents calling for help with no response
- • Staff yelling at or being rough with residents
- • Multiple serious health inspection violations
- • Pressure to sign contract same day
- • Unwillingness to answer questions or show documents
- • Locked medication carts left unattended
- • Residents restrained without clear medical need
⚠️ Serious Concerns
- • Most residents in beds or wheelchairs with no activity
- • Staff too busy to speak with you or seem frazzled
- • High staff turnover (>30% annually)
- • Can't provide recent inspection reports immediately
- • Vague answers about staffing ratios or nurse availability
- • Poor food quality or presentation
- • No posted activity schedule
- • Residents look unkempt (unbathed, unchanged clothing)
What to Do If You See Red Flags
- Document what you observed - Take notes, photos if allowed
- Check recent inspection reports - See if concerns were previously cited
- Contact the state ombudsman - They can investigate complaints
- Look for alternatives - Don't settle for a facility that raises concerns
- Report safety issues immediately - Call state health department if you witness abuse or neglect
Making Your Final Decision
After researching and touring facilities, you'll need to narrow down your choices and make a final decision. Here's how to approach this difficult choice:
Decision-Making Framework
Compare Top 3 Choices Side-by-Side
Use our free comparison tool to see Medicare ratings, costs, and quality measures in one view. Focus on health inspection ratings and staffing levels as your primary criteria.
Trust Your Gut About Culture Fit
Beyond ratings, consider: Did staff seem genuinely caring? Were residents engaged and comfortable? Could you see your loved one thriving there? Culture fit matters for quality of life.
Involve Your Loved One (If Possible)
If your loved one is cognitively able, let them participate in the decision. Their comfort and buy-in will help with the transition. Visit together if possible.
Verify Availability & Insurance Before Committing
Confirm they have an available bed, accept your insurance, and can accommodate any special needs. Get this in writing before signing contracts.
Review Contract Carefully
Never sign on the spot. Take the contract home, read every page, understand costs, services included, and discharge policies. Consider having an elder law attorney review it.
Remember: You Can Always Transfer
If a facility doesn't work out, you're not stuck forever. Residents have the right to transfer to another nursing home. While not ideal, knowing you have this option can ease the pressure of making a "perfect" decision. Focus on finding a safe, quality facility now, and adjust later if needed.
What If You Need to Decide Quickly?
Hospital discharges often force families to choose a nursing home in just 3-7 days. While not ideal, you can still make a good decision quickly by focusing on essentials:
🚨 Emergency Nursing Home Selection (72-Hour Timeline)
Day 1: Research Online (2-3 hours)
- • Use our urgent search tool to filter by insurance and location
- • Check Medicare ratings - focus on health inspections (must be 3+ stars minimum)
- • Call top 5 facilities to verify bed availability
- • Narrow to top 3 based on ratings, availability, and location
Day 2: Tour Facilities (half day)
- • Schedule tours at all 3 facilities (morning or mealtime)
- • Ask critical questions: staffing ratios, RN availability, specialized care
- • Observe: cleanliness, staff demeanor, resident engagement
- • Trust your gut - if it feels wrong, cross it off
Day 3: Decide & Paperwork (2-3 hours)
- • Choose your top facility based on safety, quality, and gut feeling
- • Review contract (focus on costs, services, discharge policy)
- • Complete admission paperwork
- • Remember: you can transfer later if needed
Your Rights During Hospital Discharge
- ✓You cannot be forced to choose a specific facility. You have the right to select from available options.
- ✓The hospital must provide a list of Medicare-certified facilities that can meet medical needs.
- ✓You can appeal discharge if you feel it's too soon (contact hospital patient advocate).
- ✓Medicare covers up to 100 days of skilled nursing care after a 3-day hospital stay (conditions apply).
Start Finding Quality Care Today
You now have the knowledge to confidently choose a nursing home that provides safe, compassionate care. Use our free tools to search 75,000+ facilities, compare Medicare ratings, and find the right fit for your family.
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