Choosing a nursing home for a loved one is an emotional and financially stressful process, but with careful planning and thorough questioning the process can be a bit easier.

Before choosing a nursing home, consumers should visit potential facilities more than once, preferably during three different shifts and carefully observe what's happening around them, the experts suggest.  

Questions to Ask before a Visit

1. Is the facility licensed by the state?

“Be sure the facility is licensed by the state and check the state's licensing bureau to make sure there are no major violations cited,” Heather Frenette, RN and certified geriatric care manager, says. “Many states have this information online.”

2. Does the facility have insurance? 

Many facilities have cut costs and have dropped their liability insurance, which can lead to problems. “If they are negligent and you sue and win, you may wind up with keys to the front door as opposed to any monetary compensation,” Frenette says. 

3. What access do the residents and their families have to an ombudsman or ombudsman volunteers?  How does the facility cooperate with the ombudsman program? 

Call the office of the local area agency of aging and ask to speak to the local ombudsman about potential facilities. An ombudsman should be able to familiarize prospective residents with the facility, staff or residents. 

“Ask for help in getting additional government survey information for the last two to three surveys, which are done once each year,” suggests Elma Holder, founder of the National Consumer Voice for Quality Long-Term Care. 

The ombudsman can also answer any questions regarding the activities, medical care and staff.

Check the facility out on the federal government web site, which contains information about all facilities surveyed by the Medicare and Medicaid programs, which license facilities.

Question to Ask the Staff

When visiting facilities, be sure to engage the staff.

“The most critical element is the find out how the staffing is,” Holder says. “Speak with family members of currents residents and get a real feel for the environment.”

Ask questions of all levels of staff, not just those at the top. Ask the staff to explain the mission and vision for residents under their care in the facility.  Obtain written information as well.

1. Does the staff have “permanent assignments” as opposed to being shifted around to different residents? 

Holder said to look at the staffing patterns, because a “permanent assignment” allows the staff to get to know their residents and develop strong relationships.

2. Is there enough staff to take care of the residents on all shifts? 

Holder said there should be a 3 to 1 ratio in the facility, meaning there are three staff members to each resident in order to provide sufficient care.

3. Are the members of the staff well trained? 

The staff makes up a large part of the energy and feeling in the environment, and it’s vital to know they are supportive, kind and trained professionals. The staff should encourage residents to become involved in activities and help them engage with other residents in the facility.

4. What kind of training does the staff have? 

In cases relating to special care for people with specific illnesses like Alzheimer's, find out if the facility has a specifically-trained specialist on hand.

“If your loved one has dementia and is a wanderer, do they have a locked area or some type of wander-guard system?” Frenette says. “Most facilities have areas where they excel and it is important to match the client's needs with the facility's strengths. 

Knowing there are specialists on board reassures the quality of life for residents, especially if a physical therapist is there making rounds and actively helping patients on a daily basis.

Question the Residents and Family Members

Speaking with residents and their family members is a great way to learn more about the nursing home.

Holder says to be on the look for the vital force of energy and happiness in the way the residents speak about their experiences.

1. What do they think about the place?

Holder says you can tell the energy of a place simply by being in the presence of the people filling the room. If you walk in and the environment seems dreary and unhappy with residents sitting alone and silent, there is no reason to believe it’s a positive atmosphere.

2. Do the residents have freedom to make choices? Are there personalized activities? 

Placing a loved one in a nursing home is a difficult decision, but knowing they will have the right to make their own choices regarding activities, meals and schedules.

3. How are meals offered to residents?  Do they get choices on when and what to eat?   Is their encouragement and assistance with social interaction at meal times?

Mealtime is an excellent way for residents to interact with one another and become social. Frenette advises visiting during mealtime and try the food.  

“Use this opportunity to observe whether the staff is kind and compassionate with the residents [especially those who need feeding] or if they seem rushed and impatient.”

4. Is the communication between residents and staff strong? Do the residents and family members have a voice?

Make sure there is some sort of outlet offered to residents to discuss problems and issues within the facility.