How to Find the Right Nursing Home?

In the light of recent developments in the Trump administration, that plans to eradicate nursing home residents and families the right to sue the care homes for neglect and abuse, the right choice of the nursing facility is more important than ever.

When you place a loved one in nursing home or long term care facility, you place a great deal of trust in others to care for and protect the individual you hold so dear to you. It can be a heartbreaking situation when that trust is compromised when your loved one suffers an accident or injury due to abuse or neglect by the care facility.

What Kind of Facility to Choose?

Assisted living facilities

Assisted living facilities offer plenty of available services for senior citizens, many of whom do not require the degree of medical attention found in nursing homes. If you or your loved one feel as if you would benefit from assistance with daily tasks but do not feel as if moving into a nursing home is a necessary step, you consider contacting an assisted living facility. Expenses associated with assisted living facilities vary greatly, as one facility may charge a great deal more than another. Payment assistance may be available in your area, you should consider taking the time to research which state agencies offer help with payment for assisted living facilities.

There is a wide degree of variance between different assisted living facilities. This includes the amount and type of services offered, the number of available staff, and the specific philosophies used by a given assisted living facility. Finding the right fit for you or your loved one is important, and evaluating the compatibility between client and housing is a useful process. For instance, assisted living facilities that encourage physical activity should be given preference over those that simply warehouse their residents behind closed doors. If a potential client is social and outgoing, a facility with a larger resident population may be more appropriate than a smaller home. In contrast, if a potential client tends to exhibit a hermit or loner personality, a smaller home may be a better fit than one that imposes unwanted social contact.

It is important to also evaluate the details outlined in the admission contract between a prospective assisted living facility and potential clients. If specific provisions within an admission contract do not meet your standards, or if you notice the absence of important details or agreements, inquire as to whether or not you can modify the contract to meet your needs. Further, a contract should include specific provisions regarding any decisions to end the agreement. It is standard for a facility to give a thirty-day notice pending a decision to end a contract or terminate residency. In addition, you should find out the specifics listed in the contract regarding the advent of poor health in a resident, including the name and contact information of anyone in charge of making a decision regarding transferring of a resident or elimination of a contract.

Keep in mind that assisted living facilities share many of the same issues as nursing homes and other care facilities. As with nursing homes, the availability of staff and the general appropriateness of fit between client and facility are important factors to consider in choosing an assisted living facility.

Rehabilitation Centers

Rehabilitation centers are responsible for providing short-term recuperative care for those individuals in transition between care facilities, i.e. when transferring between a hospital and a care home or other alternative living arrangement. Rehabilitation centers typically employ a staff of on-site licensed nurses who provide twenty-four-hour assistance to residents. An array of services are offered by on-site nurses at rehabilitation centers, including postoperative recovery care, physical therapy, pain management, treatment for wounds, IV therapy, and more. Rehabilitation services include physical rehabilitation, speech rehabilitation, and occupational rehabilitation. These services are provided by on-site therapists and are designed to aid patients in the recovery of independent functioning within the shortest possible amount of time.

Alzheimer’s Specialty Centers

Alzheimer’s specialty centers are intended for those individuals experiencing mid to late stages of Alzheimer’s disease or other cognitive disorders. Individuals experiencing memory disorders such as Alzheimer’s disease can utilize the specialized treatment provided by Alzheimer’s specialty centers. The success-oriented programming treatment available at memory-care facilities meets the unique needs of individuals suffering from Alzheimer’s disease and other cognitive disorders. Highly structured daily programs available to residents at Alzheimer’s specialty centers facilitate the recovery and maintenance of the cognitive and functional abilities of residents for the longest possible amount of time.

Other Specialty Centers

Specific nursing centers and care facilities provide unique and attractive features, including apartment or townhouse-style living arrangements, expansive dining accommodations, recreational activities, and more. Features relating to security and comfort are available in specific nursing centers and care facilities, and many locations offer a lifestyle similar to that provided by standard retirement homes and communities.

What To Look For?

Oftentimes this abuse and neglect is part of a pattern at some facilities. It’s not uncommon for relatives and loved ones to have no idea that any of this is going on. Those who are the victims of abuse and neglect can be apprehensive about coming forward, fearing increased abuse. Sometimes victims simply don’t wish to burden their loved ones, and sometimes victims are physically and mentally unable to communicate how they are being treated. Regardless, there are several warning signs that should be taken into account when determining whether or not your loved one might have been subject to abuse or neglect in the care of a nursing home or long term care facility.

  • Cuts and Bruises, Broken Bones, Sprains or Fractures with no apparent explanation, some fresh, some in the process of healing
  • Mood Swings, Increased Sensitivity and Defensiveness, and overall Changes in Behavior Patterns
  • Bedsores and Pressure Ulcers
  • Evidence of Sexual Abuse, Contracted STD’s and Bleeding

Additionally, it is important to observe changes or suspicious activity by those employed by the care facility. Ask yourself, are staff members refusing access or delaying visits to your loved one? Do staff members refuse to allow the resident to be alone with his or her visitors? Are valuables or other possessions turning up lost or stolen? These individuals are the ones you are placing your trust in to protect and care for your loved ones, anytime something “doesn’t appear to be right,” action should be taken immediately.

It is important to take the necessary time to properly research and investigate a nursing home before allowing a family member to take up residency at any given care facility. Be careful not to focus on properties relating to physical appearance when evaluating a potential nursing home. An attractive tour that showcases expensive furniture and a pleasant staff does not necessarily reflect the reality of the environment in which your loved one will be spending their days.

Visiting With Residents

Establishing a relationship with at least one existing resident in a prospective nursing home will help you to evaluate a facility from the inside. Whereas a guided tour may be misleading, visitations with pre-existing nursing home residents will provide accurate information regarding the conditions of a given care facility.

Use visitation time to explore the physical surroundings of the facility. Making conversation with bedridden and wheelchair-bound residents will allow you to investigate the cleanliness of the facility as well as the hygiene of the residents. Take time to notice the physical appearance of residents, including hair, nails, and teeth. Evaluate the emotional and mental disposition of the residents, taking time to notice any visible signs of depression or unhappiness. If the majority of the residents you come in contact with appear to be out of touch or unable to maintain a regular conversation, be cautious about the nursing home in question.

Avoid Restricted Access Facilities

Avoid nursing homes where visitor access is restricted. If a facility only allows visitation with specific clients who are willing to socialize, this should be seen as cause for concern. Although every care facility will have certain areas that are inaccessible to visitors and the general public, be cautious of nursing homes that only allow selective access to common areas or those that impose restrictions regarding visitation, or only allow visitation with a select group of willing residents

Notice Odors

Take notice of any odors surrounding the physical elements of a facility as well as the residents themselves. Noticeable odors of urine or feces surrounding the common areas, rooms, or residents of a facility could be an indication of improper treatment. Health hazards related to lack of proper care (changing of clothing) can include such potentially life-threatening illnesses as urinary tract infections and decubitus or pressure ulcers (bedsores).

Time Your Visits

Plan your visits so that they occur at various times throughout the day. Visiting a facility during the day may provide a much different picture than what is seen at night. Often, a nursing home may appear to be more adequately staffed during daytime than during the evening or on weekends. Be sure to evaluate the conditions of a prospective care facility at various times and on different days.

Visit During Meal Times

Visiting during meal times allows you to observe how the residents are being fed, and if they are being fed properly. Take notice of the amount of time each staff member spends with each resident, how much food is being eaten by the residents, and the visible physical health of the residents that are eating. Compare the general physical stature and size of the residents in the dining room to that of those senior citizens you see outside of nursing homes. If residents appear to be too thin, this should be cause for concern.

Take time to notice the eating habits and conditions of those residents who are fed in their beds. If the residents are unable to properly access their food, if the food appears cold, or if required aide assistance appears to be unavailable or scattered, be reluctant of the nursing home in question. If it is possible to eat a meal yourself, take advantage of the opportunity to judge the quality of the food based on taste, freshness, and temperature.

Check for Water

Every room should include a pitcher of fresh ice water, easily accessible to the resident. Staff should be providing water to those residents unable to obtain it themselves, and clean cups should be available in each room.

Evaluate the Staff

Inquire about the amount of available staff working at a care facility during various shifts, morning, afternoon, and evening. Request information regarding the number of available nurses and aides on duty, as well as the amount of certified nursing assistants (CNAs) present at any given time.

Compare the ratio of staff to residents. Take note of the number of wheelchair-bound or bedridden residents, as these clients require additional care related to daily activities, such as showering, drinking, eating, toileting, and grooming. If there is a large population of those residents in need of additional attention or special care, there should be an adequate number of CNAs on staff. With a greater population of bedridden or wheelchair-bound clients, the ratio of CNAs to residents should be smaller. Specific state licensure rules and regulations are available and should be double-checked when evaluating the staff-to-resident ratio of a care facility.

Check the State Survey

As required by Medicare regulations, the most recent state survey of a residential care facility should be readily available on site. Take the time to read through the state survey carefully, taking notice of any concerns relating to fundamental nursing and medical care.

Medicare’s guideline for nursing home facilities is an invaluable tool in the selection of a nursing home care facility. This website provides up-to-date federal survey results, residential population statistics, and information regarding management and ownership of specific nursing homes.

Talk with Family Members

Introduce yourself to the relatives of existing clients in prospective nursing homes. Take the time to discuss the nursing home in which their loved one resides, and make note of any potential concerns or issues that you may have. If friends and family members of an existing client in a prospective nursing home have experienced difficulties with the care facility, it is likely that your loved one will experience similar problems.

Other Tips

In addition to the previously mentioned suggestions regarding assessment, there are several other useful steps that can be used in evaluating the suitability of a prospective home. You can help to ensure the safety and happiness of your loved one if you consider taking the following steps:

  • Introduce yourself to the administrator of a potential nursing home. The statements made via advertisements, pamphlets, and marketing directors may not be representative of what a care facility actually has to offer. By speaking with the administrator of a facility, you will be given a more representative picture than that which exists elsewhere
  • Find out how often patients in the prospective home are seen by the medical director (in terms of frequency, i.e. once a day, twice a week, once a week). If residents are not seen as often as would be expected given individual circumstances and health concerns, you might want to consider a facility with more frequent and readily available medical attention
  • Make contact with the director of nursing at the care facility in which you intend to send your loved one. Inquire about the number of available registered nurses and nurse aides on staff. Find out how many nurses and nurse aides are scheduled on each shift, as medical attention is needed more often during shifts when problems are likely to occur (specifically those during the evening)
  • Meet the Director of Nursing and find out the number of registered nurses and aides who work each shift – especially at night when most problems occur
  • Schedule specific and useful times to visit a potential nursing home, i.e. during evening and weekend shifts. Use this time to evaluate the number of available staff, cleanliness of the facility, and overall appearance of the nursing home (disposition of residents, aesthetic characteristics, etc)
  • Research a potential nursing home by contacting Medicare and Medicaid. These organizations can provide you with archived copies of reports and inspections for specific nursing homes. Use this database to evaluate prior reports and inspection results for any care facilities that you are considering. You may contact Medicare and Medicare by visiting their website ( or by phone at (604) 367-2102

Payment Options

Like any other business, nursing homes and care facilities share the common goal of generating profit. Combined, the nursing home business has generated over fifty-five billion dollars in revenue. Roughly one-quarter of the beds provided by nursing homes in the United States are owned by one of the ten largest publicly-traded nursing home chains. A large degree of economic synergy and resource-sharing exists within the nursing home business. Often, nursing home companies will provide monetary compensation to other related companies, for fees or other services. Further, certain companies will provide economic compensation to their own subsidiaries to provide for staffing services (such as management), dietary supplies, or other services provided by their care facility.

Nursing homes may be privately owned, publicly operated, non-profit based, or charity-related. However, a lot of care facilities are managed by for-profit organizations and management companies with the goal of generating revenue. Take the necessary time to research the organizational structure of a prospective care facility, including the names and contact information of those individuals responsible for operating and managing a potential choice for nursing home or care facility. It is essential to know who is in charge of the happiness and safety of yourself or your loved one before choosing a nursing home.

The specifics regarding Medicare compensation as outlined by the reimbursement formula have changed in recent years. Members of Congress have recently lobbied to amended potential cuts in reimbursement, which would allow for operators of nursing homes to receive more funding. However, this litigation is still in the initial stages of development. As a result of Congressional litigation, the stock prices of publicly traded nursing home companies have been subsequently reduced.

When looking into a potential care facility, you may find it useful to research the up-to-date information regarding Medicare legislation and reimbursement formulas at the specific time in which you decide to choose between the various options for care facilities. New legislation regarding Medicare is constantly taking effect, and issues relating to medical treatment of senior citizens remains the subject of public debate.