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10 Red Flags to Watch For When Touring Nursing Homes

NHC

Nursing Home Care

February 7, 20269 min read

You can check all the star ratings you want, but nothing beats walking through a facility and using your eyes (and nose).

Here's what to look for—and what should make you turn around and leave.

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1. It Smells Bad

Let's start with the obvious one: if it smells like urine or feces, run.

A faint medical smell? Normal. A slight odor in one room because someone just had an accident? Fine. But if the whole place reeks, that means:

  • Staff aren't changing residents promptly
  • Cleaning isn't happening regularly
  • There aren't enough staff to keep up
  • What you might smell:

  • Urine or feces (worst case)
  • Strong disinfectant (trying to cover up smells)
  • Body odor (residents aren't being bathed)
  • Spoiled food
  • Trust your nose. If it smells bad, care is bad.

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    2. Residents Look Neglected

    Look at the people living there. Really look.

    Red flags:

  • Dirty clothes
  • Uncombed, matted hair
  • Long, dirty fingernails
  • Unshaven (if that's not their preference)
  • Food stains on clothes
  • Sitting in wet or soiled clothes
  • Call lights going off with no one responding
  • If residents look like no one's taking care of them, it's because no one is.

    What good care looks like:

  • Residents are dressed and groomed
  • Hair is combed
  • Nails are trimmed
  • Clothes are clean
  • People look comfortable and cared for
  • ---

    3. People Are Just... Sitting There

    Walk down the hallways. What do you see?

    If there are rows of people in wheelchairs facing the walls, staring at nothing, doing nothing—that's not okay.

    Why this happens:

  • Not enough staff to engage with residents
  • No activities happening
  • Staff are "parking" residents in hallways to make their jobs easier
  • What you want to see:

  • Activities happening (even if it's just a small group)
  • Residents talking to each other
  • Staff interacting with residents
  • People engaged in something (TV, puzzles, conversation)
  • Boredom and isolation are forms of neglect.

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    4. Staff Ignore You (Or Seem Rushed and Stressed)

    Pay attention to how staff act when you walk in.

    Red flags:

  • No one greets you or makes eye contact
  • Staff look frazzled, exhausted, or annoyed
  • You see staff arguing with each other or residents
  • Call lights are going off and being ignored
  • Staff are on their phones instead of working
  • No one seems to know where anyone else is
  • Good signs:

  • Staff smile and say hello
  • They seem calm and organized
  • They interact warmly with residents
  • They can answer your questions
  • Residents seem comfortable around them
  • Happy staff = better care. Miserable staff = high turnover and neglect.

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    5. They Rush You Through the Tour

    If the tour feels rushed, if they won't let you see certain areas, or if they say "that wing is closed right now"—be suspicious.

    What they might be hiding:

  • Understaffing
  • Dirty or unsafe areas
  • Residents in poor condition
  • Violations they're trying to cover up
  • What you should be able to see:

  • Resident rooms (at least one example)
  • Dining room
  • Activity areas
  • Bathrooms
  • Outdoor space (if they have it)
  • Therapy areas
  • If they won't show you something, assume it's bad.

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    6. Residents Are in Bed in the Middle of the Day

    It's 2 PM on a Tuesday. Are most people in bed?

    Unless they're sick or it's designated "quiet time," residents should be up, dressed, and out of bed during the day.

    Why this is a red flag:

  • Not enough staff to get people up
  • Easier for staff if residents stay in bed
  • Depression or over-sedation
  • Poor quality of life
  • People shouldn't be warehoused in bed all day. That's not living—that's existing.

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    7. The Food Looks (And Smells) Terrible

    Ask to see the dining room during mealtime.

    Red flags:

  • Food looks unappetizing or institutional
  • It smells bad
  • Residents aren't eating
  • No staff are helping people who need assistance
  • Residents are eating alone in their rooms
  • The menu is bland or repetitive
  • Good signs:

  • Food looks decent (it won't be restaurant quality, but it should look edible)
  • Residents are eating
  • Staff are helping those who need it
  • There are choices (not just one option)
  • Special dietary needs are accommodated
  • If the food is terrible, residents won't eat. And if they don't eat, they decline fast.

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    8. Staff Can't Answer Basic Questions

    Ask the staff member giving the tour:

  • What's the staff-to-resident ratio?
  • How long have you worked here?
  • How often do residents see a doctor?
  • What happens in an emergency?
  • Red flags:

  • They don't know
  • They give vague non-answers
  • They dodge the question
  • They get defensive or irritated
  • If staff don't know basic information about how the facility operates, something's wrong.

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    9. Recent Serious Violations

    Before you tour, check the facility's inspection report on Medicare.gov/care-compare.

    Look for violations related to:

  • Abuse or neglect
  • Medication errors
  • Infections
  • Falls
  • Unsafe conditions
  • Inadequate staffing
  • One or two minor violations? Normal. But repeated serious violations mean the facility doesn't care about fixing problems.

    Ask about violations during the tour. See how they respond. Do they own up to it and explain what they've changed? Or do they get defensive and make excuses?

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    10. Your Gut Says Something's Off

    This one's intangible, but it matters.

    If you walk in and feel uncomfortable, uneasy, or like something's just "off"—trust that feeling.

    Maybe you can't pinpoint exactly what's wrong. Maybe everything looks okay on paper. But if your instinct is screaming "no," listen to it.

    You know what a caring environment feels like. You know what respect and dignity look like. If you're not seeing it, keep looking.

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    What to Do If You See Red Flags

    During the tour:

  • Take notes
  • Ask direct questions
  • Trust your instincts
  • After the tour:

  • Compare multiple facilities (visit at least 3-5)
  • Talk to current residents and families (ask them when staff aren't around)
  • Come back at a different time of day or day of the week
  • Check online reviews (but take them with a grain of salt)
  • If you see serious issues:

  • Report them to your state health department
  • Contact the Long-Term Care Ombudsman
  • Cross that facility off your list
  • ---

    The Bottom Line

    Star ratings are helpful, but they don't tell you what it actually feels like to be there.

    Use your eyes. Use your nose. Use your gut.

    If a place feels wrong, it probably is. Keep looking.

    Your loved one deserves better.

    Tags
    #Choosing a Facility#Quality#Tours
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