Five things to consider when choosing a nursing home

Although it’s an emotionally difficult decision to make, more than half of older adults in the U.S. will spend time in a nursing home. Some will be there for a shorter stay to recover and undergo rehabilitation after a serious illness or injury. Others may need to stay longer if family and friends are no longer able to meet their needs for care and support after the progression of Alzheimer’s disease or another condition that makes them unable to safely carry out activities of daily living like getting in and out of bed, dressing, using the bathroom, and preparing food.

If possible, it’s helpful to plan ahead and visit the nursing homes you’re considering before your loved one needs care. To create a list of potential facilities, ask your family member’s primary care physician if she or he has any recommendations and use evidence-based online resources such as Medicare’s Nursing Home Compare site and ProPublica’s Nursing Home Inspect site to gather information. A health advisor can also be a good resource for unbiased information that can help you make an informed decision.

The next step is to visit the nursing homes on your list to get a firsthand sense of whether they would be a good fit for your family member, spouse, or partner. During your visit, ask questions and observe what’s going on around you as you tour the facility. These are some of the key things to carefully consider:

• Staffing: The members of the nursing home’s staff are the people your loved one will have the most contact with. They can affect not only quality of care, but also your family member’s quality of life. Ask what the facility’s staffing ratios are for registered nurses, licensed practical nurses, and certified nursing assistants. You’ll also want to know what staff turnover rates are (because high turnover can negatively impact care and be a sign of underlying administrative and systemic problems at the facility) and how much time each day staff spend with each resident. Watch and listen to how the staff interact with residents and with each other to help gauge what the resident experience is like.
• Atmosphere: Beyond making sure the facility is clean, well kept up, and doesn’t feel too institutional or impersonal, listen to the noise level on the resident floors and in the common spaces. Especially for people living with Alzheimer’s disease and other types of dementia, noisy, chaotic settings can increase confusion, agitation, and anxiety.
• Safety: Especially in light of the COVID-19 pandemic, it’s important to know what steps the facility takes to lower the risk of infections including the flu, c. difficile, norovirus, MRSA, and urinary tract infections. Ask about recent outbreaks and the number of residents who were infected as a way to gauge how the facility handles infection control. You’ll also want to know how they communicate infection and outbreak-related information to families of residents so you’re aware of what’s happening. Another key safety question to ask is how long on average residents wait between the time they request help and the time staff arrives to help them. Long waits for help can increase the risk of falls and other accidents.
• Meeting resident’s needs: If your family member has been diagnosed with Alzheimer’s disease or dementia, ask whether the staff has special training focused on caring for people with these conditions. Are there safeguards to protect residents who might wander? Does the facility frequently used medications to calm agitated residents? Is there a memory care unit?
• Quality of life: In addition to making sure the staff is respectful and caring, find out what activities are available for residents, how often they take place, and what the staff does to encourage residents to participate. Are residents required to eat their meals and get up and go to bed following a strict schedule or is there some flexibility? Are there regular opportunities for resident’s to safely spend time outdoors if they’d like to? You’ll also want to find out if the nursing home’s values and priorities align with those of your family member, for example, how do they approach issues surrounding the end of life?