The idea of nursing home placement can bring up some strong emotions from your loved one and family members. It can be hard to face the idea of heading to a nursing home, but circumstances might make it unavoidable. Before all of that, however, it is important to recognize what you need to know. what you need to be prepared, and what questions you should ask the nursing home.
Jump ahead to these sections:
- Questions to Ask Before You Start Choosing a Nursing Home
- Questions to Ask the Nursing Home Itself
- Questions to Ask Nursing Administrators
- Questions to Ask Nursing Home Social Workers
- Questions to Ask Nursing Home Residents
Long-term care options can be a real jungle to navigate, and making decisions about your loved one’s care can be overwhelming and confusing. Going through our questions and considerations will give you the confidence to make the right choice for your family.
Questions to Ask Before You Start Choosing a Nursing Home
Before jumping into a decision about choosing a nursing home, take a deep breath, and consider these questions. By going through a carefully thought-out process, you can make a more informed decision.
If your loved one is ready for a nursing home, there might be some urgency depending on where they live, but do what you can to think things through. Consider the pros and cons of a nursing home.
1. Is there any other alternative?
Consider augmenting care for your loved one. If your family member is in assisted living, chances are you may have already been told their staffing cannot adequately care for them. Private caregiving, even with the extra cost, may still be less than a nursing home. If your loved one has nursing needs, you could hire a private nurse, but those costs could skyrocket.
If your family member is at home, identify the tasks they need help with. Use home health to the fullest extent possible to provide support and rehabilitation once home health is finished. Look at continuing therapy services outpatient. It is worth figuring out if you can pay for private caregivers to assist with bathing, grooming, transfers, meal preparation, transportation, and medication reminders.
Don’t rule out assisted living as a viable option. Talk with the admission coordinator about your loved one’s circumstances and if assisted living is a possibility.
If your loved one has dementia, would a memory care community be able to meet their needs? Memory care units have a higher staff to resident ratio and can manage challenging behaviors. If you are a family caregiver, you may have reached the end of your rope, and nursing home care may be the only option.
2. What’s the long-term prognosis?
Talk to your loved one’s physician about their long-term prognosis. See if you can get some answers about whether there is a chance for rehabilitation to the point where a less restrictive community might work.
A physician might be hesitant to give you directives, but get as much information as you can about your loved one’s condition so you can plan accordingly. Their health may change or diverge from your expectations, but maintaining contact with your loved one’s physician can better prepare you to respond with the appropriate levels of care.
3. How will you pay for care?
Nursing homes are the most expensive care available because they are like small hospitals. Many nursing home facilities feature 24-hour nursing care and provide medical interventions like IV medications, catheter, wound care, and x-rays. The availability of that kind of care is expensive.
Many people exhaust their financial resources and look to other sources to pay for a nursing home. In most cases, that means qualifying for state Medicaid. The prudent thing to do is take a good hard look at your loved one’s financial picture if you haven’t already. Meeting with an estate planning professional who specializes in asset protection might be a good idea.
Compare the cost of in-home care or supported assisted living compared with the monthly cost of nursing home care.
4. What criteria is important for you?
If you have decided to pick a nursing home, make a list of essential criteria for you and your loved one before going to our next series of steps. You may not fulfill your entire set of priorities, but it is a good place to start. Consider these criteria and think of some of your own.
- Does your loved one have dementia, and if so, what specific care you would like to see given?
- Is a smaller nursing home better than a larger one?
- The state Ombudsman program will have complaints about any specific nursing home. If you have a couple of places in mind, contact the program to inquire about any safety investigations.
- Is the nursing home Medicaid certified in case your loved one needs to qualify for Medicaid?
Questions to Ask the Nursing Home Itself
Putting together a list of questions for the nursing home will give you some confidence going into a very challenging decision. Keep in mind that the answers you get may not always be completely accurate, but use your intuition, backed up by facts from the Ombudsman program, to get a clear picture.
5. What kind of protocols do you have for infection control?
Considering the devastating effects of COVID on nursing home residents, there may be no more important question to ask. According to the U.S. Government Accountability Office
Infection control problems in nursing homes were widespread before the pandemic. Find rates of COVID infections per county at the Centers for Medicare and Medicaid Services website. Even without the pandemic, the annual flu can be devastating for those with fragile health conditions. Check with your state health department for other infection issues at the nursing homes under consideration. Beyond the COVID data, it is worth asking the following questions:
- What are the specific safety protocols currently in place?
- What is the status of personal protective equipment for staff?
- What is your quarantine policy if a resident or staff member contracts COVID or another illness?
6. What is the visitation policy?
It is important to ask about the visitation policy for two reasons. Number one, can you visit the nursing home before making a decision? Number two, can you see your family member after they are admitted? If visitations are limited or unavailable, ask about access using video conferencing to check in on your loved one. If you are allowed to visit before admission, look for the following clues regarding the care they provide for their residents.
- Observe cleanliness throughout the facility.
- Notice staff interactions with residents. Does the staff seem hurried or patient? Do they show respect and compassion?
- Note odors such as a strong smell of urine, as that may be an indication that the staff is not attending to a resident’s incontinence needs.
- Ask to see the rehabilitation room. This is the space used for physical and occupational therapy.
- Look at the activities schedule. Is it filled with options or is it scant?
7. What do the care plan meetings look like?
Care plan meetings are required to take place every three months in any Medicare or Medicaid certified nursing home. The importance of these meetings cannot be overstated, especially if visitations are rare or prohibited because of a pandemic. The care plan meeting goes over your loved one’s physical and mental status, goals of care, and adjustments to care.
When considering a particular nursing home, ask these questions about care plan meetings:
- If you can’t be at the meeting in person, is there flexibility in scheduling?
- Is there the possibility of a video conferencing option? That way, you can see your loved one as well and get their input during the meeting.
- Who specifically will be present at the meetings? Request attendance by the director of nursing, therapies, and the aide supervisor.
8. How are complaints handled?
If you have an issue with care or some other complaint, ask who and how to contact that person.
Make sure to write down their contact information, as you don’t want to get lost in a maze of people without getting results. Also, request a copy of the most recent state survey.
9. How do they handle food requests and choices?
Inquire about special diets or other individual dietary needs, and if these requests be accommodated. Nursing homes are accustomed to providing medically necessary dietary prescriptions for swallowing issues like soft or pureed diets.
But what about vegetarian or gluten-free options or other food likes and dislikes? It is important to ask about that especially if your loved one is a picky eater or has had a long-standing diet in place.
10. How many personal belongings can fit in a room?
Many nursing homes have shared rooms. A shared room can oftentimes leave little room for personal furniture and belongings. Ask about the size of the room and how many personal items can be accommodated.
Your loved one may also have possessions that are comforting and reassuring. Is there room for these items?
11. What kinds of activities and therapies are provided?
Activities might be an afterthought in your mind, but they are a valuable part of everyday life in a nursing home. When there are a lot of activities available, your loved one can make sure to stay mentally fit and avoid depression as well as becoming frail. Ask to see the activities schedule and the possibility of one-on-one attention, if necessary.
It is also important to ask about physical and occupational therapy schedules. In long-term care settings under Medicaid, therapy services may be limited, but find out what they are and how they are scheduled for your loved one. What do the therapy options specifically entail? Are you able to communicate with the therapy staff about your family member’s needs?
Questions to Ask Nursing Administrators
The buck stops with the nursing home administrator. The nursing home administrator is involved in all aspects of a nursing home’s operations. Nursing home administrators oversee a broad landscape of changing terrain. They manage the facility’s staff, including training, hiring, and scheduling. They also control the organization’s finances and budgets, manage billing and reimbursement, and monitor payroll.
Some of their more critical responsibilities include ensuring that the facility complies with federal and state regulations, that the building meets safety requirements, and that patient data is secure.
A nursing home administrator can’t personally handle all of these duties, so they hire people to oversee various departments. Some nursing home administrators are very accessible, and others aren’t. However, there might be times when going to a nursing home department head doesn’t resolve your concern. At that point, you should be able to contact the nursing home administrator about your problem.
12. What are the results of inspection reports on the nursing home?
Federal law requires regular inspections of nursing homes and those findings are public. Ask to see those reports and pay close attention to infection control issues. Infection control is a significant issue in nursing homes and never more so than during COVID. If infection control seems to be a problem you may want to avoid this particular nursing home.
13. What is the rate of staff turnover?
You can expect a high turnover rate in nursing homes but pay close attention to the nursing staff. Although aides often leave for less stressful or better paying jobs, a stable nursing staff demonstrates more continuity of care and a supportive working environment.
14. What are your policies and procedures for controlling infections?
Ask to see the safety and infection control protocols for staff. Most nursing home residents share a room with someone else, so if that person becomes sick, you will want to know how your loved one will be protected.
15. How do you ensure that every resident, regardless of cultural, ethnic, religious, or sexual orientation is protected?
Ask to see requirements for sensitivity training. Everyone deserves to be free from discrimination and abuse. If your loved one falls into a category where they may feel threatened, you want to feel confident that the handling of complaints is expedient and competent.
16. What is your policy on chemical restraints?
The use of medications to control behavior is not unheard of, although many healthcare professionals consider them inhumane. But, that doesn’t stop nursing homes from using them on residents. Ask what the policy is regarding their use and require that you be contacted first if this is considered for your loved one.
17. What activities and amenities are available?
Ask to see an activities schedule. In addition, inquire about how your loved one will access activities if they have mobility or cognitive issues. Are there any other amenities such as transportation, private gathering rooms for family, or the ability to use a workout space?
18. What is the staff to resident ratio?
Many for-profit nursing homes can skimp on staff, and this can be dangerous for residents. Residents who have dementia require more care. If your loved one has dementia, you want to know that there is staff available to attend to their needs and keep them engaged.
19. What is the best way to contact you?
There are few things more frustrating than not being able to get a hold of someone when you need them. Sometimes it is a matter of the method. Ask if email or a call is better and what hours the administrator prefers. If you want to meet in person, you have the right to do so but may have to accommodate the administrator’s time frame.
Questions to Ask Nursing Home Social Workers
The social work role in nursing homes is sometimes misunderstood or underestimated, since they do so much. Social workers have the responsibility of maximizing the well-being and quality of life of residents. They identify the resident’s psychosocial needs by assessing the resident and ensuring that the staff and environment meet those needs. Social workers work on the front end during the admission process and on the back end when a resident is discharged.
20. What specifically is your role in patient care?
Not every nursing home will be the same concerning the social work role. By knowing a social worker’s responsibilities as it relates to your loved one’s care, you can save yourself time and energy. The social worker can explain in more detail what each staff person is in charge of so you can go to the right person with concerns.
Be prepared with questions about referrals to outside medical providers, advocacy, problems with other residents, discharge criteria, among other things. Will the social worker help a resident apply for Medicaid if necessary?
21. Can you help if my loved one has symptoms of depression or anxiety?
If your loved one has symptoms of depression or anxiety, what can a social worker do to help to treat those conditions? Does the social worker offer counseling, or can they connect your loved one to the appropriate resources? Being in a nursing home can be very disruptive and challenging, and your loved one should have access to mental health services.
22. Do you attend all interdisciplinary meetings?
Every nursing home is required to conduct interdisciplinary meetings where the department heads, the resident, and the family can discuss issues and concerns. This is also an opportunity to adjust the care plan to continue to meet the resident’s needs and involve the resident in that planning process. The social worker is an integral part of the team and should be at every meeting to discuss psychosocial needs.
23. How do you assist with end-of-life decisions?
Inquire about the social worker’s expertise regarding end-of-life decisions and their comfort level in knowing when to recommend hospice. Can they assist with other tasks such as referral for establishing wills and trusts? Can the social worker arrange for spiritual services?
24. What is the best way to contact you?
Some social workers have office hours or an open door policy. Ask about the most efficient way to ask questions or voice complaints. Waiting for the interdisciplinary meeting may be too long, and you could have issues that need urgent attention.
Questions to Ask Nursing Home Residents
Sometimes a nursing home will paint a rosy picture of how great they are. But how do you find out what the day-to-day experience is really like? One way is to ask nursing home residents, keeping in mind that some people will skew towards the negative if they are unhappy about being there in the first place.
Try and talk with as many residents as you can so that you get a well rounded, and hopefully, accurate view of what the nursing home is really like. Ask as many questions as you can think of during your visits.
26. How long do you have to wait for an aide when you call?
Knowing what the wait times are for help will tell you a lot about staffing ratios. If someone has to wait 30 minutes or more, generally speaking, that is a long time if your loved one is uncomfortable or needs to use the toilet. If residents are consistently waiting for staff to attend to their needs, this is not a good sign.
27. Tell me about the activities.
You can tell by their response how much effort goes into developing a diverse activities calendar for all residents. While some residents may not have the most positive point of view regarding some activities, you can judge for yourself whether or not the calendar will be helpful for your loved one. Also, ask about whether the staff is available and willing to help people with activities they are interested in.
28. How would you describe the attitude of the staff?
You could get a range of answers on this one, giving you some insight into whether the staff is happy and not overworked. What you want to listen for are answers like “caring, “compassionate,” and “competent.” Everyone has bad days, and one or two impatient reactions are normal, but if the overall attitude of the staff is negative, that is something to be concerned about.
29. What do you like the most and least about this nursing home?
The answer to this question could reveal things that you never thought of—for example, maintenance issues, security, privacy, and accessibility to staffing department heads. Evaluate what residents say by knowing what your priorities are- there are some complaints about some things that may be unacceptable to you.
30. How is the food?
Be prepared for most people to say that it is awful! But ask specific questions about variety, temperature, and timeliness of meal delivery. No one gets everything they want when it comes to food in a nursing home, but you should expect good, nutritious, fresh choices.
31. Have you noticed a turnover in staff?
A nursing home resident can report on staff turnover because it is something they notice. It is one thing for someone to be on vacation, but a constant turnover and lots of staff changes is an indication that people aren’t happy. A resident who has been in the nursing home for a while will notice if there is someone different every day.
32. Is the nursing home clean?
Ask residents if the rooms, bathrooms, common areas, and dining room are kept clean. When so many people—many of whom aren’t entirely ambulatory—reside in close quarters, things can get messy. Cleanliness is essential for infection control and the overall health of the residents. Staff should always wear gloves.
Keeping Questions in Mind to Ask a Nursing Home
No matter when you make the choice, it can be difficult to assess what nursing home is the right one for your loved one. Like all living choices, this choice is not one you want to make quickly.
Asking the right questions and taking your time to review all the available options out there can make the difference between a nursing home that just meets your basic needs and one that exceeds your expectations.
If you're looking for more on long-term care planning, read our guides on dementia home care and how to decide if your parent's ready for a nursing home.
Sources
- “Infection Control Deficiencies Were Widespread and Persistent in Nursing Homes Prior to COVID-19 Pandemic.” U.S. Government Accountability Office. gao.gov
- “COVID-19 Nursing Home Data.” Centers for Medicare and Medicaid Services. data.cms.gov
- “What’s a Care Plan in a Nursing Home?” Medicare.gov. medicare.gov