Tip Sheet: Finding Quality Nursing Home Care

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Nearly 1.6 million older Americans live in nursing homes.

The move to a nursing home can be difficult for older adults and their family members. If you’re considering moving an older relative to a nursing home, Healthinaging.org experts offer the following advice for finding the best possible care:

Before you choose a nursing facility

Check licensure, certifications, qualifications, and care
When touring a nursing home:

  • Ask to see the nursing home’s license.
  • Ask if the nursing home is Medicare and/or Medicaid certified.
  • Ask about the services the nursing home offers. For example, does it provide wound management for residents who develop bedsores? Some nursing homes have physician wound consultants and others have home-grown wound teams. How about physical rehabilitation services? Do they have a special unit for older adults with dementia?

Get to know the staff, particularly the social workers

Try to meet with the nursing home administrator and nursing director. These two leadership positions are very important to maintaining quality care in the nursing home. Social workers also play an important role in the nursing home and in communicating with family and caregivers.

When visiting a nursing home, think about your comfort with staffers:

  • Are they friendly? Do they answer questions from both residents and family members?
  • Are routine care planning meetings held at convenient times for family?
It’s important to get to know the staff and create a “partnership relationship” with those who will be caring for your family member. The better the communication and interaction between staff and relatives, the better residents will fare.

Check out facility cleanliness and safety
Here are some things to look for in a nursing home:

  • Are there handrails in the bathing areas and hallways?
  • Are there plenty of safe walking areas inside and outside?
  • How many staffers are working at a given time during different shifts?
  • Are there emergency and evacuation plans in place in case of fires, floods and other hazards?
  • Are the bed rails or guard rails on nursing home beds raised up? Raised guard rails on beds pose a serious injury risk for older adults, and should rarely be used to restrain patients. Likewise, residents sitting in chairs should not be restrained with seat belts or trays. 

Make sure residents with special nutritional needs are well-nourished
Find out how staff help residents who have special dietary needs or are unable to feed themselves. Some questions you can ask are:

  • Does the staff try to feed the residents out of bed? What strategies do they use to do so?
  • Does the nursing home accommodate special dietary needs, such as for people with food allergies or certain medical conditions? 
  • Take a look at the dining room. Look at how the food is served. Is it on trays or from steam tables?

Evaluate routines and activities
Residents in nursing homes who don’t have dementia or other cognitive problems should be able to make choices about their daily routines. For example, they can decide when to go to bed, and when to bathe.

In special care units for residents with dementia, however, it should be clear that the nursing home follows a consistent routine. This is especially important for residents with dementia. Staff in the special care unit should have training in dealing with behavioral and psychological symptoms of dementia.

You should also consider the range of activities offered. Activities help nursing home residents remain social and stimulated. These may include:

  • arts and craft classes
  • chair exercise programs
  • religious services
  • discussion groups
  • entertainment (for example, such as musical and dance performances or movie nights)
Ask the nursing home if they can provide other activities if your family member has difficulty participating in the existing options.

After you’ve placed your family member in a facility

Keep visiting!
Seeing family is very important for your family member’s well-being. So make frequent social visits. Your visits will help your family member feel happier and comforted by your presence. He or she will also feel more settled in his or her new home.

If you make regular visits you’re also more likely to notice signs of new health problems or injuries or other changes in your family member that may be overlooked by staff. You are also more likely to notice changes in the nursing home staff that could affect quality of care. 

Be on the lookout for signs of neglect or abuse
If you see an older adult—your family member or any other resident—who is wearing dirty clothing, looks malnourished, or appears to have untreated health problems, you can take the following steps:

  • First, speak to the charge nurse, the nursing supervisor, or even the director of nursing or director of social work.
  • If you are still unhappy with how the matter was handled, you can contact an ombudsman (someone who is in charge of looking into poor administration or possible violation of rights).
  • In extreme cases, you can also call the Department of Health. 

Nursing homes are required to post information on how you can report complaints. You should be able to find numbers to call from the nursing home. 

In addition, pressure ulcers (also known as “bed sores”) can be evidence of possible neglect. Pressure ulcers are a painful breakdown of the skin that results in mild redness and swelling or, in extreme cases, in deep wounds and infection. Bruises may be signs of abuse.

Visit the nursing station often
You should stop at the nursing station each time you visit. You can monitor your family member’s daily activities and ask about any changes in medications, diet, behavior, sleep or exercise.

You or another caregiver should be contacted immediately if a problem occurs, such as if the older adult falls or begins wandering. As a caregiver, you have the right to be informed.

For additional information and to compare nursing homes in your area, go to Medicare’s Nursing Home Compare website.

 

Last Updated August 2019

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