Visiting nursing homes is the most important part of choosing one because it gives you an opportunity to observe the quality of life and care in facilities. During your visits, there will be many questions to ask and things to look for. Some of your questions will be answered through your own obsevations. Others will need to be answered by staff, residents, or other visitors.

Tour the entire home

• Are the rooms and corridors clean, tidy and free of foul odors?
• Do the rooms have privacy curtains, bed stands, and individual closets?
• Do residents have their own belongings in their rooms?
• Is there a nurse call light by each bed?
• Is there fresh drinking water within reach of residents?
• Are the state inspection reports and nursing home license posted in a public place? Are they current (within the last year)?

Visit during a meal

• Does the food look appetizing?
• Do residents eat together and talk with each other?
• Are aides helping people who need assistance?

Observe how resisdents and staff interact

• Are residents treated with respect by the nursing home staff?
• Is the staff attentive to residents' needs?
• Does there appear to be enough staff? At night and on weekends?
• Are residents properly dressed, clean, and active?
• If possible, speak with some of the residents to get their impressions.

Ask what services the home provides

• What special and recreational services are offered, and how often do they occur?
• Are there activities in the evenings and on weekends?
• Is there a residents' council?
• How are residents' dental, eye, and hearing needs met?
• Are there physicial, occupational, and speech therapy? How does a resident qualify to receive these services?
• Is there a program for the prevention and treatment of incontinence?
• How does the home provide for mental health needs of residents?
• What is the physician's name and telephone number? How often does he or she see residents? Who is available in emergencies?
• Request a copy of the home's rules and policies.

Ask the administrator about the nursing staff

Nurses aides provide most of the care in nursing homes. They are also called CNAs, which is an acronym for Certified Nursing Assistant. Find out what kind of training and orientation is given to the CNAs. How often is training updated, and by whom? How long have most CNAs worked there? A home with high employee turnover has difficulty giving good quality care. Ask about qualifications of nurses and other staff also. Are there enough licensed nurses to give adequate supervision and help to the CNAs?

Finances and admission contracts

Nursing home care can be very costly. A resident paying privately may pay $5,000 to $8,000 per month for their care. Medicare pays for a limited amount of time only if there was a prior hospital stay and the resident is in a Medicare certified facility and a Medicare certified bed. When savings and other resources are exhausted, Medicaid will pay the cost of a long-term stay in a nursing home. But, again the resident must be in a Medicaid certified home, in a Medicaid certified bed.

Not all nursing homes certify all their beds for both Medicare and Medicaid. During your visit you will want to find out if the home is a Medicare and/or Medicaid certified facility and whether all or only a portion of beds are certified for Medicare and/or Medicaid. Ask if your source of payment changes whether you will be expected to move out or move to another room in the home. If you need to be moved to another section of the home, ask whether you will have the same access to the services you were receiving.

When you enter a nursing home, you must sign an admission agreement. This is a contract that describes your legal relationship with the facility. The agreements you make in this contract are very important. They describe the services you receive, your rights and responsibilities, and the charges for your care.

If you are considering admission to a nursing home, get a copy of the admission contract as soon as possible. Most are long and contain legal terms. The more time you, your representative, or your attorney has to review an admission contract, the better. Some contracts contain illegal requirements, others may be legal but not acceptable to you. Therefore, you may want to negotiate changes to the contract.

Nursing Home Checklist

Cost

• Is the facility's daily rate reasonable?
• Are there extra charges beyond the daily rate?
• Is financial assistance (Medicare, Medicaid) available?
• Do I have to guarantee payment out of my own funds?

Environment

• Is the facility clean, tidy, and free of odor?
• Is the facility homelike? Or is it very institutional?
• Are small day or activity rooms available and in use?
• Are residents encouraged to bring personal possessions?
• Are there safe indoor and outdoor areas available?
• Do residents have access to private space? Private use of a telephone?

Meals

• Do meals meet residents' dietary needs and accommodate their preferences?
• Do residents receive assistance with meals as needed?
• Are residents given sufficient fluids?

Staffing

• Do staff members have necessary skills?
• Does the facility appear to have enough of a staff?
• Does the staff receive orientation and ongoing training?
• Is the staff stable? Or is there a lot of turnover?
• Does the staff seem to have a caring attitude?
• Is there an atmosphere of warmth and friendliness?
• Are social services available? What kind of assistance is provided?

Continence

• What is the facility's toileting program?

Care

• How does the facility use physical and chemical (psychotropic drugs) restraints?
• Who will be the resident's attending physician? Is he or she readily available?
• Are mental health services available and delivered as needed?
• Are residents well groomed?
• Will the facility meet all of the person's care needs for therapy and other specialized services?

Residents' Rights

• Are residents treated with dignity and respect?
• Are privacy needs met?
• Were you given information about other resident rights?

Activities

• Do residsents appear active and involved in life in the facility?
• Is there a regular program of activities?
• Is there a qualified staff person to coordinate activities?
• Are their joint activities for residents and families?

Transfers and Discharge

• Did the facility explain when transfers are required?
• Are residents transferred or discharged from the facility when their money runs out?
• Are resisdents transferred or discharged from the facility when their care needs increase?

Family Involvement

• How are families involved?
• Does the facility involve the family in creating a comprehensive, individualized care plan?
• Are family members allowed to make treatment decisions? Under what circumstances?
• Is there an active family council?

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