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How to choose a nursing home for—and with—aging parents

June 29, 2022, 2:00 PM UTC
Senior man in wheelchair, with adult son
Over 1 million seniors a year enter a skilled nursing facility, but not all nursing homes are created equal.
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You may have years to decide on next steps for parents whose health needs require a higher level of care than home or assisted living can provide, or you may find yourself faced with the decision abruptly after an unexpected surgery or diagnosis. Either way, decisions have to be made, and ideally you’re part of the process.

According to AARP’s national Home and Community Preferences Survey, 77% of adults 50 and older prefer “aging in place”—staying in their homes as they grow older—over moving somewhere else for help. For example, after a hospitalization, a home health nurse can make rounds to your parent’s house to change dressings and manage medications during a short-term recovery period following surgery or an injury. Similarly, home health aides can help with long-term daily care such as bathing and prepping meals when aging makes those activities more difficult. 

But for many, that option is either too stressful or too costly. In order to qualify for Medicare coverage for home care, your parent has to be considered “homebound,” meaning they have a condition that makes it hard for them to leave the house. Otherwise, it’s an out-of-pocket expense. 

Over 1 million seniors a year enter a skilled nursing facility. These nursing homes may be part of a continuing care retirement community that progresses from independent living to assisted living to skilled nursing care, or they may be stand-alone facilities. These facilities provide support to people who don’t need the level of care a hospital provides but still need 24-hour supervision, three meals a day, and assistance with everyday activities. 

But not all nursing homes are created equal. What works for you and your family may not for another. Here’s how to navigate the selection process and match your needs to the right nursing home.

Schedule visits, ask questions

Word of mouth often carries a lot of weight. Ask friends and family you trust for recommendations in your area as a starting point. You can also use tools such as the U.S. Administration on Aging’s Eldercare Locator, which can connect you to services for older adults in your area and beyond.

Once you’ve identified several places of interest, call and make an appointment for a visit. Going in person gives you and your parent the chance to meet the staff and residents and tour the facility. It also gives you the opportunity to ask questions—and to talk with not just employees but also the people who live there. 

Questions you may want to ask include…

  • Who makes up the medical staff here?
  • What forms of therapy are available?
  • What types of meals do you serve?
  • What activities do you offer?
  • What are your visitor policies?
  • Do you offer preventive care such as dentistry and optometry on-site?
  • Do you offer dementia care?

It’s important to ask questions that go beyond basics, says Dr. Vincent Mor, professor of health services policy at the Center for Gerontology and Healthcare Research at Brown University School of Public Health.

“You want to ask things like, ‘Tell me something about the company that owns this place. How many other places do they own in the nearby area?’ Not only can you look at how those places perform, you also learn whether they have other facilities to pull from in case of short staffing,” he says.  

Also telling: staff retention rate and level of integration into the surrounding health care system. “It helps to find out how many of the nurses and aides have been there for a year or more,” says Mor. “And what is the relationship of the hospital to the nursing home? Do the doctors there visit patients in that nursing home? Is the hospital embracing that nursing home as part of its care environment? Do they refer lots of patients to that place? This gives you a fuller picture of their level of care.”

Do some background checking

Your gut can tell you a lot about a place, but it’s wise to back it up with data. A good place to start is the Centers for Medicare and Medicaid Services. The federal agency offers a nursing home search-and-compare tool that rates facilities based on health inspections, staffing, and quality measures.

“Nursing homes are licensed by the state, but they’re certified by Medicare and Medicaid and inspected by Medicare and Medicaid on a regular basis, as well,” says Mor. “There’s lots of public information related to quality, how they did on their last inspection, what their staffing levels are, and hospitalization and rehospitalization rates.”

Mor says you can also find qualitative information through the agency’s patient experience surveys. “There you learn more personal details, like whether staff explain things to you in a way you understand, or how long you typically have to wait for someone to answer a call button,” he notes.  

Medicare also provides a printable nursing home checklist to take with you when you visit a facility that includes questions about safety and care, abuse prevention, food, activities, and more. 

Lead with communication

Most important, stay in conversation. Often this kind of life transition involves unfamiliar role reversals and several stages of grief. 

“People typically approach this thinking, ‘Well, I bought a house before. I’ve made decisions before. I should know how to do this,’” says Mor. “But in this context, there’s both an erosion of independence and a shift in who’s in charge, and that changes the way in which you have historically made your decisions.”

Have family talks early and often about costs, location, and personal preferences for this pivotal transition in your parent’s life—and yours—so you’re better prepared to make a choice you can all live with. 

“You’re all in it together,” says Mor. “It’s not just about the parents, it’s about the family as a whole. What are your preferences, desires, incomes? You’re making joint decisions, so you need to be open and honest with each other.”

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