Questions to Ask a Nursing Home Facility Before Choosing One

We had a frequent guest, Jean, who had grown up in Chicago. She told us how when she and her children were looking into nursing homes, she used lessons learned from her very first apartment search. Her first apartment was right near the El tracks, and she said that every time a train went by, the water in the shower would stop. Of course, she didn’t know that before she moved in.
Then, with the kind of joyfully dark humor that made us all love her, she said, “I didn’t ask any questions for my first apartment. I wasn’t going to make that mistake for my last!”
Now, Jean ended up not going to a nursing home because she didn’t find one that fit her needs and budget, and her family figured out a way to make aging in place work for them. Not everyone can or wants to do that though. That’s why, when looking at living arrangements for your aging loved one, you need to ask a lot of questions.
You have a right—and indeed, a duty—to find out as much as you can about finances, facilities, and quality of life. The questions you ask a nursing home facility before choosing one will determine the next phase of your loved one’s life. Never be afraid to ask questions. Here are 10 we think you can start with.

10 Questions Everyone Should Ask A Nursing Home Facility

• Are you Medicare/Medicaid certified? Medicare covers up to 100 days of a nursing home stay (for short-term care), and for long-term care, 45% of nursing home costs in America are covered by Medicaid. Make sure the facility is licensed for both and in good standing at the state and federal level.
• Are you equipped to handle residents with Alzheimer’s and dementia? Not every facility is equipped to take care of the neediest patients—even if it says it is. Ask detailed questions about certification and training of staff, round-the-clock care, activities like movement therapy or art, and other vital aspects of working with challenging residents.
• Are residents able to continue seeing their personal doctors? A nursing home should have an attending physician, and some homes want residents to only see that physician. But if your loved one has a relationship with a doctor, he or she should be able to continue seeing that doctor. Moving to a home can be jarring enough. You don’t want to destabilize everything.
• Does the facility have provisions for telehealth? Related to the above, telehealth and telemedicine are becoming more prevalent and important to residents. Being able to consult with doctors around the world, or to have a check up without leaving, means not having to arrange rides, fight traffic, and take up the whole day. This is increasingly easy to do when aging from home, and any nursing facility should be able to accommodate the WiFi needed to make it happen.
• Are background checks done for every employee? It’s a terrible fact that abuse happens in nursing homes, as it can with caregivers. Whether the abuse is physical, emotional, sexual, or financial, sometimes, employees take advantage of their position and power to act out and get what they want. It is a difficult job, and it takes very special people (which are most of the employees, to be clear) to handle it. Horrifyingly, 40% of nursing home residents have reported abuse. Background checks won’t stop all of this. But they will help to weed out repeat offenders or potentially violent people.
• Has your facility been cited for abuse? Nearly one out of every three facilities has at some point been cited for abuse. This can range from minor to major. This might be uncomfortable to ask but you should. Facilities that haven’t won’t mind (and will be glad that you are conscientious). Facilities that have but have cleaned up will be happy to walk you through the steps they have taken. Only those with something to hide will try to dodge the question, and then you’ve had your answer. You can find this information out online, and it is good to compare their answer with what has been reported.
• Is the facility adequately staffed? A staggering 90% of nursing home residents report that they or another resident has been neglected. Now, we know that no facility will have a 1:1 staffing to resident ratio. That’s impossible. And even in a round-the-clock facility, there will be times when the staff can’t immediately meet every demand. California law demands that facilities not equipped to handle special needs provide 3.2 nursing hours per patient per day, and those that are equipped have 2.3 nursing hours per patient per day. That’s the minimum, of course. Look for more.
• Is there any time when care isn’t available? This is non-negotiable. Care must be available around the clock. Emergencies don’t have off-hours.
• Does every room have a window? This is not a small question. When mobility is an issue, and it is hard to get outside every day, a window is literally the connection to the outside world. Not only that, but it is a source of natural light. Natural light has a potential connection to help the sleep patterns and biorhythms of the elderly, which has a direct impact on health. And is far more pleasant than endless fluorescence.
• Can I speak with other residents? You don’t want a Potemkin Village. Ask if you can talk to other residents without staff around. Most places will be happy to let you. And you should know that no one is going to be 100% happy with their nursing home; that’s human nature. Someone could be upset that there are too many fun activities and it is too lively. So don’t hold out for one where no one complains. You aren’t going to find it. But being able to have unvarnished conversations is the best way to see the full picture.

The truth is, no place will be perfect. But if you are looking for a home for your aging loved one, you need one that suits your budget, and your aging loved one’s needs and wants. It might not be his or her “last apartment,” but nor is it a halfway house. It must be a home. If not, it compounds sadness into the slowly growing dusk of aging.
That’s why many people are now looking into ways to age in place at home. Home care and support services make this increasingly possible, and better medical techniques make it more physically viable. It is an option that an increasing number of aging individuals and their families are considering. So maybe that should be question 11: Should I help my loved one age in place?
At Institute on Aging, our programs and services help older adults, their families, and caregivers explore aging together, through good times and bad, as an adventure and a journey. Connect with us today to learn more.