How to Choose a Nursing Home: A Complete Guide for Families

Choosing a nursing home for a parent or loved one is one of the most emotionally difficult decisions a family faces. You want to find a place that feels safe, dignified, and genuinely caring — but with thousands of facilities across the country, knowing where to start can feel overwhelming.

This guide breaks down the process into practical steps so you can make a confident, informed choice.

Start with What Your Loved One Actually Needs

Before touring a single facility, get clear on the level of care required. Nursing homes (also called skilled nursing facilities) provide 24-hour medical care, which makes them different from assisted living or in-home care. They are the right fit when someone needs:

• Daily help with medical tasks like wound care, IV therapy, or catheter management
• Physical, occupational, or speech therapy after a hospital stay
• Supervision for advanced dementia or Alzheimer's disease
• Round-the-clock monitoring that family caregivers can no longer provide

If your loved one mainly needs help with cooking, bathing, or companionship, assisted living or in-home care may be a better (and more affordable) starting point.

How to Research Nursing Homes

Once you know skilled nursing is the right level of care, narrow your search with these resources:

• Medicare's Care Compare tool — Every Medicare-certified facility gets a 1-to-5-star rating based on inspections, staffing, and quality measures. Start here to filter out poorly rated options.
• State inspection reports — These are public records. Look for patterns of deficiencies rather than isolated incidents.
• Your loved one's doctor — Ask which facilities they have working relationships with. Continuity of care matters.
• Local Area Agency on Aging — These free government resources can point you toward well-regarded options in your community.

Questions to Ask on Your Tour

A tour is your best opportunity to see what daily life actually looks like. Go unannounced if possible — facilities that welcome drop-in visits tend to have less to hide. Key questions:

• What is the staff-to-resident ratio on each shift, including nights and weekends?
• How do you handle medical emergencies after hours?
• What does a typical day look like for residents?
• How do you communicate with families about changes in condition?
• What is the discharge and transfer policy?
• Can residents personalize their rooms?
• How are complaints handled?

While you are there, pay attention to how staff interact with residents. Are they patient? Do they call people by name? Does the facility smell clean? These small details reveal a lot about the culture of care.

Red Flags to Watch For

Trust your instincts. If something feels off during a visit, it probably is. Specific warning signs include:

• Residents sitting in hallways unattended for long periods
• Strong odors of urine or disinfectant (a sign of inadequate daily cleaning)
• Staff who seem rushed, dismissive, or reluctant to answer questions
• High staff turnover — ask how long nurses and aides have worked there
• Unexplained bruises or weight loss in current residents
• A pattern of serious deficiencies on state inspection reports

Understanding Costs: Medicare, Medicaid, and Private Pay

Nursing home care has a CareScout Cost of Care Survey 2025 national median of $9,581 per month for a semi-private room and $10,798 per month for a private room in the United States, though costs vary widely by state and facility.

• Medicare covers up to 100 days of skilled nursing care after a qualifying hospital stay (at least 3 consecutive days). It does not cover long-term custodial care.
• Medicaid covers long-term nursing home care for people who meet income and asset requirements. Eligibility rules vary by state, and there may be waiting lists.
• Long-term care insurance can offset costs if your loved one purchased a policy before needing care.
• Private pay is the most common initial payment method. Many families eventually transition to Medicaid once savings are spent down.

Ask each facility which payment types they accept and whether they have Medicaid-certified beds. Some facilities limit the number of Medicaid residents they will take.

Your Pre-Visit Checklist

Before your first tour, gather these items so you can make the most of every visit:

• A list of your loved one's medications, diagnoses, and care needs
• Insurance information (Medicare number, Medicaid status, any supplemental coverage)
• Questions printed out — it is easy to forget things in the moment
• A notebook or phone to jot down impressions immediately after each visit
• A trusted family member or friend to come with you for a second perspective

Making the Final Decision

After visiting your top two or three options, compare them side by side on the things that matter most: quality of care, staff attentiveness, location (so family can visit easily), cost, and how your loved one felt during the visit.

There is no perfect nursing home, and it is normal to feel guilt or sadness even after making a well-researched choice. What matters is that you are advocating for the best possible care — and that means a lot.