How to Evaluate Nursing Homes & Assisted Living Facilities

Before the Tour: Do Your Homework

Walking into a facility cold puts you at a disadvantage. Preparation helps you ask better questions and recognize what you're seeing. Here's what to do before scheduling your first tour.

Research Online First

For nursing homes, visit Medicare's Care Compare website (medicare.gov/care-compare) to see:

• Overall star rating (1-5 stars based on health inspections, staffing, and quality measures)
• Recent inspection results and any deficiencies cited
• Staffing levels compared to state and national averages
• Quality measures like fall rates, pressure ulcers, and medication errors
• Ownership information and any recent changes

For assisted living and memory care, federal reporting doesn't apply, but you can:

• Contact your state's licensing agency for inspection reports and complaints
• Check the Better Business Bureau for complaints
• Read Google, Yelp, and Facebook reviews (look for patterns, not individual complaints)
• Search local news for any coverage of the facility
• Ask your parent's doctor or hospital discharge planner for recommendations

Know Your Parent's Needs

Create a clear picture of what your parent needs before touring:

• Medical needs: Medications, chronic conditions, monitoring requirements
• Physical needs: Mobility assistance, wheelchair accessibility, help with bathing/dressing
• Cognitive status: Memory issues, wandering risk, supervision requirements
• Social preferences: Activities they enjoy, religious services, outdoor access
• Dietary needs: Special diets, food allergies, feeding assistance
• Budget: Monthly amount available, insurance coverage, how long funds will last

Schedule Strategically

• Visit during the week when full staff is present
• Tour during mealtime to observe food quality and dining atmosphere
• Avoid holidays when operations may be different
• Plan for 1-2 hours per facility
• Bring a family member or friend for a second perspective

What to Observe During the Tour

Your eyes and nose will tell you things no brochure ever will. Pay attention to these areas as you walk through the facility.

First Impressions

• Smell: Should be clean and fresh, not overwhelming with air freshener or smelling of urine
• Cleanliness: Floors, surfaces, and common areas should be well-maintained
• Temperature: Comfortable throughout (seniors are often cold, so slightly warm is normal)
• Lighting: Bright enough for safety, especially in hallways and bathrooms
• Noise level: Calm and comfortable, not chaotic or eerily quiet

Resident Appearance and Behavior

The residents themselves reveal a lot about care quality:

• Grooming: Are residents clean, hair combed, dressed appropriately?
• Engagement: Do residents look alert and engaged, or sedated and withdrawn?
• Location: Are residents participating in activities, or lined up in hallways?
• Interactions: Do residents talk to each other and staff, or sit in isolation?
• Call lights: How long do call lights stay on before someone responds?

Staff Interactions

Watch how staff members interact with residents throughout your tour:

• Do they address residents by name?
• Do they make eye contact and speak at the resident's level?
• Is their tone warm and respectful, or rushed and dismissive?
• Do they knock before entering rooms?
• How do they respond to confused or repetitive residents?
• Do staff members seem happy, or stressed and overwhelmed?

Physical Environment

Common areas:

• Comfortable furniture in good condition
• Activities in progress or clearly scheduled
• Outdoor areas accessible and well-maintained
• Posted activity calendar with variety of options

Resident rooms:

• Space for personal items and furniture
• Private or semi-private options
• Accessible bathroom with grab bars
• Working call button within reach
• Window with natural light
• Temperature controls in room

Safety features:

• Handrails in all hallways
• Non-slip flooring
• Well-lit exit signs and evacuation routes
• Secured entry (especially for memory care)
• Smoke detectors and sprinkler systems

Essential Questions to Ask

Come prepared with questions. Write them down and check them off during your tour. Don't be afraid to ask follow-up questions or request specifics.

About Care and Services

• What levels of care do you provide? What would require a transfer to another facility?
• How do you assess new residents' needs and create care plans?
• How often are care plans reviewed and updated?
• Who provides medical care? Is there an on-site nurse or physician?
• How are medications managed and administered?
• What happens in a medical emergency? Which hospital do you use?
• Can residents keep their own doctors, or must they use facility physicians?
• How do you handle residents with dementia who become agitated?
• What therapy services are available (physical, occupational, speech)?

About Staffing

• What is the staff-to-resident ratio during day, evening, and night shifts?
• How many CNAs, nurses, and supervisors are on each shift?
• Is there an RN on site 24/7, or just during certain hours?
• What is your staff turnover rate?
• How do you screen and train new employees?
• Are background checks conducted on all staff?
• Do residents have consistent caregivers, or does staff rotate frequently?

About Daily Life

• What does a typical day look like for residents?
• What activities are offered? How often? Who leads them?
• Are residents encouraged to participate, or left to self-direct?
• What are the meal options? Can we see a sample menu?
• Can special diets be accommodated (diabetic, low-sodium, kosher, vegetarian)?
• Can residents eat in their rooms if they prefer?
• Are there outdoor spaces residents can access independently?
• How are religious or spiritual needs addressed?
• Are pets allowed? Are there facility pets?

About Family Involvement

• What are the visiting hours? Any restrictions?
• Can family members participate in care plan meetings?
• How will you communicate with us about our parent's condition?
• Is there a family council or regular family meetings?
• Can family members bring in food or eat meals with residents?
• How do you handle family concerns or complaints?

About Costs and Policies

• What is the base monthly rate? What does it include?
• What services cost extra? (medication management, incontinence care, etc.)
• How often do rates increase? What was last year's increase?
• What payment methods do you accept? Do you accept Medicaid?
• Is there a move-in fee or community fee?
• What is the policy if my parent runs out of money?
• What is the discharge policy? What would cause involuntary discharge?
• What is the notice period required to move out?

Red Flags to Watch For

Some warning signs should make you think twice about a facility. While one issue might be explainable, multiple red flags suggest systemic problems.

Other Concerns to Note

• Residents lined up in hallways with nothing to do
• Sedated-looking residents who seem over-medicated
• Staff ignoring residents who try to get their attention
• Lack of personal items in resident rooms
• Dining room that's empty during mealtimes (residents eating alone in rooms)
• No current activity calendar posted
• High-pressure sales tactics or urgency to sign immediately
• Unwillingness to provide references from current families
• Vague answers about costs or "it depends" without explanation
• Excessive use of physical restraints

Evaluating Staff Quality

The quality of care your parent receives depends almost entirely on the people providing it. Staff quality is the single most important factor in facility selection.

Staffing Ratios Matter

Higher staffing generally means better care. Ask for specific numbers and compare:

Signs of Good Staff Culture

• Staff greet you warmly and seem happy to show off their workplace
• Employees know residents by name and their preferences
• Low turnover means consistent caregivers who know residents well
• Staff speak positively about management and the facility
• Training programs and advancement opportunities exist
• Adequate staffing allows unhurried, dignified care

Talk to Staff Directly

If possible, chat briefly with CNAs or aides (not just admissions staff):

• "How long have you worked here?"
• "What do you like best about working here?"
• "Do you feel you have enough time to give residents good care?"
• "What's the hardest part of your job here?"

Their answers—and their body language—speak volumes.

Understanding Inspection Reports

State inspections happen regularly, and the results are public record. Learning to read these reports helps you make informed decisions.

For Nursing Homes

Federal regulations require annual inspections plus complaint investigations. Reports include:

• Deficiency citations: Problems found during inspection
• Scope and severity: How serious and widespread each problem was
• Plan of correction: How the facility said it would fix the problem
• Complaint investigations: Results of any reported concerns

Pay attention to:

• Severity levels (G, H, I, J, K, L indicate serious harm or immediate jeopardy)
• Repeat deficiencies (same problems cited year after year)
• Abuse, neglect, or infection control citations
• Whether problems were corrected

For Assisted Living

Regulations vary by state. Contact your state's licensing agency for:

• Most recent inspection report
• Any complaints filed and investigation results
• License status and any sanctions
• Ownership history

Understanding Costs and Contracts

Senior care is expensive, and billing can be confusing. Make sure you understand exactly what you're paying for before signing anything.

Get the Full Cost Picture

The advertised "base rate" often doesn't include everything. Ask specifically about:

• Level of care fees: Additional charges based on how much help your parent needs
• Medication management: May be included or cost extra
• Incontinence care: Often a significant additional charge
• Laundry and housekeeping: Included or extra?
• Transportation: To doctor appointments, shopping, outings
• Therapy services: PT, OT, speech therapy
• Beauty/barber services: Usually extra
• Cable TV and internet: Included or per-room charge?

Request a written estimate showing the likely total monthly cost for your parent's specific needs.

Review the Contract Carefully

Before signing, understand:

• Rate increase policy: How often can rates increase and by how much?
• Discharge policy: Under what circumstances can the facility ask your parent to leave?
• Notice requirements: How much notice for voluntary move-out? Required from facility?
• Refund policy: What happens to deposits if your parent moves out or passes away?
• What's required: Any mandatory arbitration clauses waiving right to sue?
• Payment terms: When is payment due? Late fees?

Payment Options

Understand what payment sources the facility accepts:

• Private pay: Out-of-pocket payment
• Long-term care insurance: Verify the facility is approved by your policy
• Medicare: Only covers skilled nursing care short-term (rehab after hospitalization)
• Medicaid: Covers nursing home care for those who qualify; not all facilities accept it
• Veterans benefits: Aid & Attendance may help cover costs

Facility Comparison Checklist

Use this checklist to compare facilities side-by-side. Rate each category and take notes during your tours.

Making the Final Decision

After touring multiple facilities, it's time to decide. Here's how to approach this significant choice.

Make Return Visits

For your top 2-3 choices:

• Visit unannounced at a different time (evening or weekend)
• Attend a meal or activity
• Talk to current residents and family members
• If possible, bring your parent to visit

Talk to Current Families

Ask the facility for references, or approach families you see during visits. Questions to ask:

• How long has your loved one been here?
• How is the care quality? Any concerns?
• How responsive is staff to requests or problems?
• What surprised you after moving in?
• Would you choose this facility again?

Trust Your Gut

Data and checklists matter, but so does your instinct. After all your research, ask yourself:

• Would I be comfortable living here?
• Did the staff seem genuinely caring?
• Did residents seem content and well-cared-for?
• Can I imagine my parent being happy here?

Involve Your Parent

If your parent is cognitively able to participate:

• Include them in tours when possible
• Ask their preferences and priorities
• Respect their input, even if it differs from yours
• Remember, this will be their home

Remember: You Can Change

Choosing a facility doesn't have to be permanent. If the care isn't meeting your parent's needs, you can move them. Many families do. The most important thing is to start somewhere that seems good and monitor the care closely.

Frequently Asked Questions