How to Choose a Nursing Home: The Ultimate Checklist

Selecting a nursing home (skilled nursing facility) for a loved one is a major decision that requires careful evaluation. Unlike assisted living, nursing homes provide 24-hour nursing care and supervision — with skilled services and therapies as needed — for individuals with serious physical or cognitive conditions. (Physicians typically visit periodically rather than being on-site around the clock.)

This checklist is designed to help you conduct thorough evaluations during your facility tours. Print this page and take it with you.

1. Initial Research & Certification

• Is the facility Medicare and/or Medicaid certified?^[2]
• Check the facility's rating on the CMS (Centers for Medicare & Medicaid Services) Care Compare website.^[2] Avoid facilities with consistent 1- or 2-star ratings.
• Are there any recent severe health inspection violations or abuse citations?
• Is the facility currently accepting new residents?

2. Facility Environment & Cleanliness

• Is the facility free from strong, unpleasant odors? (While occasional accidents happen, pervasive odors are a red flag for understaffing).
• Is the temperature comfortable?
• Are the hallways well-lit and free of tripping hazards?
• Are the residents' rooms clean, personalized, and comfortable?
• Is there a secure outdoor area for residents to enjoy fresh air?

3. Staffing and Care Quality

• What is the staff-to-resident ratio during the day, night, and weekends?
• Does the staff knock before entering a resident's room?
• Do staff members address residents by their preferred names and interact with them respectfully?
• Is the facility's Director of Nursing accessible and willing to answer questions?
• What is the turnover rate for nursing staff? (High turnover can severely impact continuity of care).

4. Medical Services & Specialized Care

• How quickly can a physician or nurse practitioner be reached, and how often do they visit?^[1]
• Does the facility offer specialized care for conditions like Alzheimer's or Parkinson's?
• What is the protocol for medical emergencies? Which hospital do they partner with?
• Are physical, occupational, and speech therapy services available on-site?

5. Quality of Life & Activities

• Are residents dressed appropriately for the time of day and season?
• Does the food look and smell appetizing? Are alternative meals available if a resident dislikes the main option?
• Can residents choose when to wake up, go to bed, and bathe?
• Is there a robust calendar of varied activities (not just television)?