How to Choose the Right Facility: A Practical Guide to Evaluating Nursing Homes

Choosing a nursing home or long-term care facility is one of the most important decisions families make for an aging loved one. You want a place that is safe, respectful, medically competent, and supportive of quality of life. Below are practical tips you can use when researching options, questions to ask on the phone and in person, what to observe on a tour, key quality indicators to check, and ways to involve family members in the decision.

Start with basic research

Begin by creating a short list of local facilities. Use referrals from your physician, hospital discharge planners, local Area Agency on Aging, and state health department websites. Look up inspection reports and the Centers for Medicare & Medicaid Services (CMS) ratings if available in your country. Narrow your list to three or four places to visit.

Questions to ask before the tour

• What is the current staffing ratio? How many licensed nurses are on duty overnight?
• Is the facility Medicare- and/or Medicaid-certified? What payment options are accepted?
• Can I see the most recent inspection or survey report and responses to any deficiencies?
• What is the staff turnover rate, and how long have key staff been employed?
• How are medical emergencies handled and how quickly is physician or advanced practice provider care available?
• What is included in the basic fee, and what extra services cost more?

What to look for during a tour

Visit more than once, at different times of day (morning, mealtime, evening) to get a realistic picture. During the tour, observe the following:

• Cleanliness and smell: The facility should be clean and well-ventilated without strong odors.
• Staff interactions: Staff should address residents respectfully, respond promptly, and interact warmly.
• Resident condition and activity: Residents should be dressed appropriately and appear engaged in activities, not isolated in rooms.
• Safety features: Handrails, emergency call systems, secure exits for memory-care units, and fall-prevention protocols.
• Food and dining: Ask to see a menu and, if possible, observe a mealtime. Food should look appetizing and there should be choices for special diets.
• Private vs. shared rooms: Check room size, privacy options, storage, and natural light.

Key quality indicators

Quality indicators give measurable information about care standards. Important indicators include:

• Staffing levels and stability — higher registered nurse hours and lower turnover usually mean better care.
• Use of physical restraints and antipsychotic medications — lower use is preferred.
• Rates of pressure ulcers and infections — frequent or untreated issues are red flags.
• Hospital readmission rates and emergency transfers — frequent transfers can indicate poor on-site care.
• Survey deficiencies and complaint history — read the written reports and the facility’s corrective action plans.

Ask to speak with residents and family members

Talking directly to current residents and their families can provide unfiltered perspectives. Ask about satisfaction with staff responsiveness, activities, meals, and how concerns are handled. Keep in mind that some residents may be reluctant to criticize a place where they live; try to talk to multiple people.

Review policies and contracts carefully

Request written policies on admissions, discharge, transfer, visitation, and grievance procedures. Read contracts for included services, charges for additional services, refund policies, and termination terms. If possible, have an attorney or a trusted advisor review any long-term contract.

Include family and the resident in the decision

Make selection a team process. Designate one family member to lead communications and coordinate visits. Hold a family meeting to weigh priorities: medical needs, social preferences, budget, and proximity for visits. If the resident can participate, honor their preferences for location, room type, and daily routine. Establish a trial stay or respite stay if the facility allows, to evaluate the fit without committing long term.

Practical tips for the day of the move

• Pack familiar items: photos, a favorite blanket, comfortable clothing and personal hygiene supplies labeled with the resident’s name.
• Bring a list of medications, primary physician contact, legal documents (advance directive, power of attorney), and emergency contacts.
• Plan a schedule of visitors for the first few weeks to ease the transition.

Follow up after placement

Monitor the first 30–90 days closely. Attend initial care-planning meetings, review the individualized care plan, and set measurable goals. Keep open communication with staff and schedule regular family check-ins. If concerns arise, document them and use the facility’s grievance process while escalating to ombudsman or regulatory agencies if necessary.

Final checklist

Before you decide, confirm these items:

• You visited at various times and observed care routines.
• You reviewed inspection reports, staffing data, and quality indicators.
• You interviewed staff, residents, and families for firsthand impressions.
• You understand the contract terms, payment responsibilities, and trial-stay options.
• You have a communication plan and named decision-maker for follow-up.

Choosing the right facility takes time and preparation, but approaching the search methodically will help you find a safe, caring place that respects your loved one’s dignity and needs. Use this guide as a starting point and adapt the questions to what matters most for your family.