Nursing Home Checklist
Most stressful decision. Get it right.
Step 1: Medicare Care Compare
- medicare.gov/care-compare — FREE.
- Star ratings 1-5.
- Health inspections, staffing, quality measures.
- Pick 4-5 star locations only.
- Check most recent inspection report.
- Avoid "Special Focus Facilities" (worst).
Tour visit checklist
- Smell — clean? Or strong cleaner masking?
- Residents — engaged or sleeping in chairs?
- Staff — chatting with residents? Rushed?
- Call lights — answered quickly?
- Food — eat lunch there. Real food or processed?
- Activities — varied calendar? Posted?
- Outdoor space — accessible?
- Rooms — clean? Private bathroom?
- Visit 2-3 times unannounced including weekends.
Questions to ask
- Staff-to-resident ratio (day + night)?
- RN coverage 24/7?
- Staff turnover rate (lower = better)?
- How are bedsores prevented?
- How handle dementia behaviors?
- Falls prevention program?
- How handle urgent medical issues?
- Doctor visits — scheduled or as-needed?
- Transfer hospital partners?
- Cost + what's included?
Cost + payment
- Average: $9,000-12,000/month nationally.
- Medicare covers 100 days post-hospital ONLY.
- Medicaid covers long-term once savings spent down.
- Long-term care insurance — check policy.
- VA Aid & Attendance — for veterans.
- Self-pay until Medicaid eligible.
- 5-year look-back on Medicaid.
Once admitted
- Visit OFTEN — best advocate.
- Get to know aides + nurses by name.
- Watch for changes (skin breakdown, weight loss).
- Be present at care meetings.
- Document concerns in writing.
- Long-term care ombudsman = free advocate. ltcombudsman.org.
- Switch facilities if quality declines.
Alternatives first
Most seniors want to stay home. Consider in-home care + adult day care + assisted living before nursing home. Nursing home best for those needing 24/7 medical care. PACE program (see /tools/adult-day-care-guide) — alternative for Medicaid-eligible.