Choosing and Evaluating a Nursing Home

Can there be a more difficult job than finding a nursing home for a parent or spouse? No one wants to live in a nursing home. They serve as institutions of last resort when it's impossible to provide the necessary care in any other setting. And, typically, the search takes place under the gun when a hospital or rehabilitation center is threatening discharge or it's no longer possible for the loved one to live at home. Finally, in most cases, finding the right nursing home is a once-in-a-lifetime task, one you're taking on without the experience of having done it before.

That said, there are a few rules of thumb that can help you:

• Location, location, location. No single factor is more important to quality of care and quality of life of a nursing home resident than visits by family members. The quality of care is often better if the facility staff knows that someone who cares is watching and involved. Visits can be the high point of the day or week for the nursing home resident. So, make it as easy as possible for family members and friends to visit.
• Get references. Ask the facility to provide the names of family members of residents so you can ask them about the care provided in the facility and the staff's responsiveness when the resident or relatives raise concerns.
• Check certifying agency reports. Medicare's Nursing Home Compare is a free site that allows consumers to compare the quality of the nursing homes they're considering, using Five-Star Quality Ratings, health inspection results, nursing home staff data, quality measures, and fire safety inspection results. Also, CareScout is an unbiased source for ratings and reviews of eldercare providers nationwide. Detailed nursing home reports are available for a fee.
• Talk to the nursing home administrator or nursing staff about how care plans are developed for residents and how they respond to concerns expressed by family members. Make sure you are comfortable with the response. It is better that you meet with and ask questions of the people responsible for care and not just the person marketing the facility.
• Tour the nursing home. Try not to be impressed by a fancy lobby or depressed by an older, more rundown facility. What matters most is the quality of care and the interactions between staff and residents. See what you pick up about how well residents are attended to and whether they are treated with respect. Also, investigate the quality of the food service. Eating is both a necessity and a pleasure that continues even when we're unable to enjoy much else. It is also advisable to try and get a tour of the facility that is not prearranged. While this is not always possible, it does give you the opportunity of seeing an unrehearsed atmosphere.

For more pointers on evaluating nursing homes, see our checklist.