Prospecting a Nursing Home – What to Look for and What Questions to Ask

When you speak to a nursing home representative it is a good idea to have a pre-prepared list of questions you’d like to ask. Skilled nursing facility (SNF) personnel will welcome your questions and are eager to allay your concerns.

Talk to your loved one to determine what is most important to his or her mental well-being and then be sure that the nursing home you choose will be able to fill those needs. Observe residents to see if they appear happy. If possible, talk to them about how they like their living arrangements.

The following questions are a good starting point.

State Licensing and Federal Certification

  • Is the home licensed to operate in its state?
  • Is the home certified by the Federal Department of Public Health?

Virtually all states have their own licensing procedure mandated by the state’s Department of Health and Welfare. Federal law requires that state inspection reports are posted where anyone can review them. This is something worth looking for when doing an on-site visit.

Facilities that accept Medicare and/or Medicaid patients must also be certified by the federal government Department of Public Health’s Medicare/Medicaid Division, which requires these facilities to adhere to specific safety standards and other regulations designed to protect residents.

Staff to Resident Ratio

  • Are registered nurses, licensed practical nurses, and certified nurse aides on duty around the clock?
  • Are there trained physical, occupational and speech therapists on site or available when needed?
  • Does the staff include an Activity Director, or at least a designated individual who organizes “fun” things? Are daily activities listed on a calendar that is posted in every resident room?
  • Are there adequate crews to handle housecleaning and laundry?
  • Do patients have access to an ombudsman to air any complaints?

It is vitally important for a nursing home to have both an adequate patient-staff ratio and the appropriate personnel to fill the varied needs of their residents. Smaller facilities may strive to house residents with similar needs and, for practical reasons, may bring in various specialists, like therapists, on a part-time. Your list of questions should include:

Shared Vs. Personal Living Space

  • Does the facility offer both single and shared rooms?
  • Are both options available or is there a waiting list?

Residential nursing homes vary in size from eight to 300 or more beds. Small facilities offer a homier atmosphere that fosters friendships between residents and greater intimacy with staff.  Small SNFs are also more likely to have such easily reached outdoor communal spaces as porches and/or patios. Large facilities generally provide in-house physical therapy, greater food choices, and more activities.

Facility Grounds and Amenities

  • Are individual rooms and communal areas clean and cheerfully decorated?
  • Are the grounds attractive and well cared for?
  • Are doorways and halls wide enough to be easily maneuvered by a wheelchair?
  • Are the rooms large enough for each person to have a closet, dresser, and at least one visitor’s chair?
  • Is the facility well ventilated and free of unpleasant odors?
  • Are wheelchairs and other equipment kept clean and in good working order?
  • Are hallways well lit at night and are patient rooms equipped with a night-light?

The physical environment can make all the difference in the world to the happiness of residents. An institutional-like setting with a cheerless, bland décor has a dampening effect on a person’s spirits. Most modern nursing homes attempt to make the facility warm and homelike. Staff members usually wear cheerful clothing to complement the pleasant environment.

Food and Nutritional Considerations

  • Does the facility employ a dietician who ensures nutritionally sound meals?
  • Are special diets like low-salt, low-cholesterol, vegan, and Kosher honored?
  • Are between-meal snacks and beverages available?
  • At what hour are meals served?
  • Can they be eaten either in the communal dining room or in one’s own room?
  • Can residents invite guests for meals and, if so, at what extra cost?

Be sure to ask if attention is paid to patient preferences and dislikes so that your mom who can’t stand the sight or smell of liver won’t find it delivered to her bedside!  Larger facilities are more apt to have a greater variety of food with menus from which residents can make their own choices.

Leisure Activities and Exercise

  • Does each bed have its own TV?
  • Is computer access available?
  • Are exercise programs offered?
  • Are cognitive stimulation games played for the memory impaired?
  • Is there ample interaction with other residents?
  • Are visiting hours flexible?
  • If physically able, can the resident leave with a relative or friend for a few hours or a day?

It is important for SNF residents to stay as physically and mentally active as possible. To this end, nursing homes offer such things as exercise programs (including those that can be done from a seated position), bingo games, movie showings, beautician services, and arts & crafts lessons. Communal areas should be furnished with jigsaw puzzles, card tables/cards, chess, checkers and other board games for residents to enjoy.

Safety Protocols and Policies

  • Are call buttons amply placed in bedrooms, bathrooms and hallways?
  • Are calls answered in a timely manner?
  • Is the bathroom area and shower stall equipped with safety bars?
  • Are the toilet seats high enough for ease in sitting and getting up?

Safety is paramount. A 2003 report by the Centers for Disease Control and Prevention maintained that falls are the number one cause of injury deaths among seniors. Falls currently still compete for that dubious distinction with automobile accidents. Strategically placed call buttons are not only important in the case of a fall but quick response to a call button can prevent injury on the part of residents who get tired of waiting for a response and attempt to get up or go to the bathroom by themselves.

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