Nursing Home Selection Checklist

Check Medicare Star Ratings

Go to Medicare.gov/care-compare and look up each facility. Check overall star rating (5 stars is best), health inspection rating, staffing rating, and recent violations.

Read Inspection Reports

Look for patterns—one minor violation is fine, but repeated serious violations (like medication errors, abuse, or neglect) are red flags.

Call Ahead

Ask if they have beds available, if they accept your insurance/Medicaid, what the monthly rate is, and when you can tour. Some places won't let you drop in unannounced.

Plan to Visit 3-5 Facilities

Don't pick the first one you see. You need to compare. Quality varies wildly even within the same area.

How Does It Smell?

Nursing homes shouldn't smell like urine or feces. A slight medical smell is normal, but strong odors mean residents aren't being changed promptly.

Is It Clean?

Look for dirty floors, overflowing trash, food spills, or cluttered hallways. A little messiness is normal, but it should generally be clean and well-maintained.

How Do Residents Look?

Are residents dressed and groomed? Are they sitting in the hallways looking bored, or are they engaged in activities? Do they seem happy or depressed?

Are Staff Friendly?

Do staff smile and greet you? Do they interact warmly with residents? Or do they ignore you and seem rushed or stressed?

What's the Staff-to-Resident Ratio?

Ask how many residents each CNA is responsible for during the day and at night. Lower is better—1 CNA for 8-10 residents during the day is reasonable. 1 to 15+ is a red flag.

How Often Do You Have Staff Turnover?

High turnover means bad management or poor working conditions—which affects resident care. Ask if staff have been there a long time.

Is a Doctor On-Site?

Ask if they have a medical director and how often doctors visit. Will they use your current doctor, or do you have to switch?

Do You Accept Medicaid?

If you might need Medicaid eventually, make sure they accept it. Ask if there's a waiting list for Medicaid beds.

What Services Are Included?

Ask what's included in the base rate vs. extra charges. Things like therapy, medications, supplies, hairdresser, and cable TV might cost extra.

Can I See the Dining Room During Mealtime?

Visit during lunch or dinner. Is the food decent? Are residents eating? Are staff helping those who need assistance?

What Activities Do You Offer?

Ask to see the activity calendar. Are there things your loved one would actually enjoy? Or is it just bingo every day?

How Do You Handle Emergencies?

What happens if someone falls or has a medical emergency? Do they call 911, or do they have a protocol? How do they notify families?

How Staff Interact with Residents

Do staff speak respectfully? Do they rush residents or treat them like children? Do they knock before entering rooms?

Call Light Response Time

Ask how quickly they respond to call lights (the button residents press for help). 5-10 minutes is reasonable. 30+ minutes is unacceptable.

Are Residents in Bed All Day?

If you see lots of residents in bed mid-day, that's a red flag. People should be up, dressed, and out of bed unless they're sick.

Check the Rooms

Look at a resident room. Is there space for personal items? Is the bathroom accessible? Are call buttons within reach?

Staff Won't Let You Look Around

If they rush you through the tour or won't let you see certain areas, that's a bad sign. You should be able to see everything.

Residents Look Neglected

Dirty clothes, uncombed hair, long nails, residents sitting in wheelchairs facing walls—these suggest understaffing or neglect.

Recent Serious Violations

Check the inspection report. Violations for abuse, neglect, medication errors, or serious health/safety issues are dealbreakers.

Pushy Sales Tactics

If they pressure you to sign immediately or won't let you take the contract home to read, walk away.

No Clear Answer on Medicaid

If they dodge the question about accepting Medicaid or say "we'll work it out later," be suspicious. Get it in writing.

Talk to Current Residents and Families

Ask residents what they think. Are they happy? What do they wish was better? Talk to families in the parking lot—they'll be honest.

Trust Your Gut

If something feels off—even if you can't pinpoint why—trust that instinct. You want to feel good about where your loved one will live.

Visit More Than Once

Come back at a different time of day (evening or weekend). See if the place looks the same when different staff are working.

Compare Your Options

Make a spreadsheet. Rate each facility on cleanliness, staff friendliness, location, cost, activities, etc. This helps you see the differences clearly.