The first time my father had to go to a nursing home, my sisters and I were incredibly nervous about choosing a facility for him. The hospital’s case manager provided a list of nursing homes in the area and we had a very short timeline to make a decision. Thankfully, one of my sisters works in health care quality and was very familiar with the process for gathering information to compare facilities. She did a lot of research, weeding out the ones with poor quality and safety ratings. Our selection was further limited because only a handful of facilities provided on-site dialysis. Ultimately, we chose a facility to which my aunt was admitted previously. She felt they had provided excellent care. We had visited her several times and found the nursing staff to be friendly and the facility to be clean. All went well for the first 2-3 weeks, then we found ourselves requesting a meeting to discuss unattended dirty laundry, inconsistent physical therapy services, and a host of other concerns. 

There are several reasons individuals require nursing home care, but the overarching theme is a need for continued care that is too complex to be managed at home but does not require the intensity of a hospital setting. Choosing a nursing home (otherwise known as a “sub-acute nursing facility”) for your loved one is a daunting task. In addition to dealing with the disappointment that your family member cannot return to their home, you are being asked to make decisions for which you are ill-prepared.

When choosing a nursing home, be sure to consider the following:

1) Quality

It is imperative that you research nursing home facilities prior to making a decision. Do not trust that the hospital’s case manager or social worker has done their due diligence. While they would never intentionally send your loved one into harm’s way, they work for the hospital, whose interest is to discharge your family member as soon as possible.

CMS (Centers for Medicare and Medicaid Services) rates certified nursing homes using a five-star system for each of the following:

  • Overall rating: summative evaluation that incorporates the three items below
  • Health Inspections: based on information from the last 3 years of on-site inspections
  • Staffing: based on information about the average number of hours of nursing care provided to each resident daily
  • Quality Measures: 11 different measures that offer information about how well nursing homes care for their residents’ physical and medical needs


This information is available on the nursing home compare website in a user-friendly manner that allows you to compare facilities. The website also has copies of the inspection reports and formal complaints. Reading through these documents can be very enlightening.

In addition to the official CMS ratings, be sure to solicit “word of mouth” referrals if possible. Ask the doctor(s), friends, family members, and neighbors if they have experiences with the local nursing homes and solicit their opinion. A facility may looks good on paper, but nothing can replace inside knowledge.

2) Location

It is important to choose a facility that is close to family members or friends who can check on the patient/resident frequently. Having a regular presence in the facility will help ensure your family member is receiving appropriate care and allow you to address any deficiencies promptly.

3) Bed availability

Not all nursing homes have available beds. Be sure to call the facility and speak to the Admissions Director to inquire about open beds and how soon they are able to accommodate your loved one.

4) Services

  • Medical services: All nursing homes must have a physician contracted to provide medical care and oversight. Many facilities also have specialists, like podiatrists, ophthalmologists, psychiatrists, and dentists, who provide on-site consultation for residents when necessary.
  • Therapy services: Since rehabilitation is a primary need for most residents admitted to nursing homes, the quality of therapy services is extremely important. Facilities should provide both physical and occupational therapy to residents.
  • Dialysis: If your family member receives dialysis, you will either need to choose a facility that provides this on-site or you will need to arrange transportation to a dialysis facility.
  • Transportation: Some facilities provide transportation for residents to attend medical appointments or dialysis sessions. This can be incredibly helpful.
  • Health/Beauty: While this is not a necessity, having a hair salon and/or barber shop on-site can be very convenient.
  • Spiritual health: Facilities may offer religious services on-site or may provide transportation to local places of worship.
  • Social activities: The resident’s emotional health is a key element of their recovery. Facilities should provide some form of organized social activities, such as movies, group games, outings, and exercise classes.


5) Facility

Before finalizing your decision, I strongly recommend that you visit the facility in person. If you cannot do this, designate another family member. You will need to note things like responsiveness of staff to residents, friendliness of staff, security, cleanliness, upkeep/maintenance, room size, and privacy.

I wish I could tell you that if you follow all of these steps, you will choose a top-notch facility that will provide exceptional care. There are no guarantees and I have certainly been disappointed after due diligence, but NOT doing your homework will almost certainly result in an undesirable outcome.

In summary, when choosing a nursing home facility for your loved one consider the following to-do list:

  1. Find nursing homes in your area. Narrow the list down to 5-10.
  2. Compare the quality of the nursing homes you selected on the nursing home compare website and solicit input from others with personal or professional experience.
  3. Review the services offered at each facility.
  4. Visit the nursing homes in person (or designate a trusted family member or friend to do so).
  5. Make a final selection.


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