It’s not often you hear the phrase “nursing home” spoken of in a positive light.

Nursing home horror stories frequently capture the nation’s interest and underscore important questions about quality and inspection. But is the negative press more hype than hazard? While very real problems do exist, some say the biggest problem is people’s tendency to expect – and thus, accept – the worst.

Speak up

“Nursing homes overall do a very good job of providing care,” said Robert Bua, chief executive of nursing home ratings company CareScout. “Like I say, there will always be good actors and bad actors. But there’s plenty of information out there for people to make an intelligent choice.”

Still, when it comes to knowing what to expect of a nursing home, consumers may be failing themselves. People faced with the decision to place a loved one in a nursing home are often unfamiliar with the amount of say they have in their loved one’s care, said Eric Carlson, directing attorney at the National Senior Citizens Law Center.

Carlson, who authored 20 Common Nursing Home Problems – and How to Resolve Them, believes people should be more assertive when it comes to the care of their loved ones, making sure they voice their concerns right from the start.

“Amongst consumers there needs to be more of a sense of entitlement. Consumers should have higher expectations because they’re entitled to them,” he said.

Take the residents' care planning meeting, for example, at which residents, family members and nursing facility staff draft a plan for the resident. Carlson believes residents and their families need to be “seriously and aggressively” engaged in this meeting, making sure to cover everything – from when the resident will get up in the morning, to what he/she will eat, to the specifics of administering medication. If not, residents run the risk of getting a cookie-cutter plan that may not be the right fit, Carlson said.

Speaking up not only benefits the resident, but also the nursing home staff. Getting a clear picture of a resident’s needs is an important way for the nursing staff to develop a connection with that resident.

“It’s a way to get to know them,” said a certified nursing attendant at Isabella, a nursing facility located in New York City.

To cover all bases, experts recommend residents and families be aware of their rights, which can be found on the Medicare Web site.

Know what to look for

The best advice for scoping out a nursing home is to go with your gut and follow your nose – literally.

“Good nursing homes try the best they can to look and feel like home,” said Susan Reinhard, director of the AARP’s Public Policy Institute. Experts suggest going into the dining room, tasting the food, and taking note of any unpleasant odors along the way. If the facility smells like popcorn, that’s a good sign – not just because it may mean there’s a resident “movie night” going on, but because the smell of popcorn is found to be a potent appetite stimulant for older adults, she said.

As for the things you can’t smell – there’s help. Experts recommend consulting the Centers for Medicare and Medicaid Services’ (or CMS) Web-based nursing home comparison tool, which provides quality records and inspection history for every certified nursing home in the nation. Users of the tool have access to many important details about the nursing homes they’re considering – from a home’s nurse-to-resident ratio to the percentage of residents given flu shots. That information is then put side-by-side with state and national averages to give users a full picture of where each home stands.

Finally, prospective residents and their families should consult Medicare’s Nursing Home Checklist, which offers insight into what to look for when it comes to resident and staff appearance, living spaces and bathrooms, menus, activities and overall safety.

Options abound

One of the biggest deterrents for those considering nursing home care is the cost – and for good reason. Nursing homes are the most expensive long-term care option, said Reinhard of the AARP, with many residents spending all their assets within six months or less.

Which is why knowing when to choose a nursing home is just as important as the nursing home you choose. More and more health care alternatives are being made available to the ailing population, said Wilmarie Gonzalez, state long-term care ombudsman with the Pennsylvania Department of Aging.

“I think we’re evolving,” she said. “We will always need nursing homes, but people want options.”

Gonzalez has seen growing interest in assisted living facilities and adult day care, as well as a trend of “aging in place,” where the sick and elderly choose to bring outside help into their private residences.

Another major trend is nursing homes shifting away from “institutional” policies and adopting a more resident-centered philosophy of care, offering residents more day-to-day flexibility and creating a “home-ier” atmosphere for them.

“[Nursing homes] are starting to be set up in such a way that residents don’t feel like captive Medicaid reimbursement units,” said Carlson of the National Senior Citizens Law Center.

At nursing facility Isabella in New York, residents are offered a large variety of activities – from sewing and knitting sessions to Mens’ Club and movie nights, while interacting with head nurses and community directors. And the change is being noticed.

“Every floor here is like a little community,” said a certified nursing attendant who prefers to remain anonymous. “A lot of people who [transfer] to Isabella say ‘My mom’s a lot more comfortable here.’ It’s all about the quality of care.”