Choosing a nursing home for someone you love is one of the hardest decisions you’ll ever face. It’s emotional, confusing, and often rushed because a hospital discharge coordinator is pressuring you to “pick something by Friday.” That pressure leads to bad choices. The nursing home questions to ask before signing anything can mean the difference between a place where your loved one thrives and one where they’re simply warehoused.
Here’s what most people don’t realize: there’s a massive quality gap between the best and worst nursing homes, and the nice lobby doesn’t tell you which category a facility falls into. What tells you is the answers to specific, pointed questions about staffing, care practices, safety records, and financial transparency.
We organized 18 questions into clear categories. Visit at least two or three facilities. Ask every question. Write down the answers. Compare them side by side. Your loved one deserves that diligence.
Before Your Visit
Preparation is everything when evaluating nursing homes. Do this homework before you walk through any doors.
- Check the facility’s inspection reports on Medicare.gov. Go to medicare.gov/care-compare and look up each facility. You’ll find star ratings, health inspection results, staffing data, and quality measures. Pay attention to any pattern of serious deficiencies.
- Confirm your loved one’s insurance coverage. Know whether they have Medicare, Medicaid, long-term care insurance, or will be paying privately. This determines which facilities are an option and what your out-of-pocket costs will look like.
- Assess your loved one’s care needs. Make a list of what they need: medication management, memory care, physical therapy, dialysis, wound care, behavioral support. Not every facility provides every service, and matching needs to capabilities is critical.
- Visit without an appointment first. Show up unannounced on a weekday afternoon. Walk the halls. Observe how staff interact with residents. Notice the smells, the noise level, and whether residents are engaged or parked in front of a TV. First impressions without the “tour polish” are revealing.
- Talk to families of current residents. If you see visitors in the lobby or common areas, ask about their experience. “Would you choose this place again?” is a simple question that yields honest answers.
Staffing and Care Quality
1. What is your staff-to-resident ratio for nurses and CNAs?
This is the single most important question you can ask. Staffing levels directly determine the quality of care. Federal standards are notoriously low, and many facilities barely meet them. Here’s what to look for:
A ratio of 1 nurse per 15 to 20 residents during the day is common, but 1 per 10 to 12 is better. For CNAs (certified nursing assistants), who handle most daily care, look for 1 CNA per 6 to 8 residents during the day, and know that overnight ratios will be higher (meaning fewer staff per resident).
Ask specifically about different shifts. Nighttime and weekend staffing is often significantly lower, and that’s when falls and emergencies happen. If the facility won’t give you specific numbers, that’s a red flag.
2. What’s your staff turnover rate?
High turnover (above 50% annually) signals problems: low pay, poor management, burnout, or all three. It also means your loved one won’t build relationships with consistent caregivers, which directly impacts care quality and emotional wellbeing.
Ask the number directly. Good facilities track this and are willing to share it. The best nursing homes have annual turnover rates below 30%. They achieve this through competitive pay, reasonable workloads, and management that actually supports staff.
3. Is there a registered nurse (RN) on-site 24/7?
Federal law requires a licensed nurse on-site 24 hours a day, but that can be an LPN (Licensed Practical Nurse) rather than an RN. There’s a difference. RNs have more training, can perform more complex assessments, and are better equipped to handle emergencies.
Facilities with an RN on every shift, including nights and weekends, provide a higher level of clinical oversight. If the facility only has an RN available “on call” during off-hours, ask what that means in practice. A nurse who’s a phone call away isn’t the same as one who’s on the floor.
4. How do you handle medical emergencies?
When a resident has a fall, a stroke, or a sudden change in condition, every minute matters. Ask about the emergency response protocol: Who responds first? Is there a crash cart on the unit? How quickly can a physician or nurse practitioner be reached? What hospital do they transport to, and how?
Observe whether staff have access to emergency equipment on the unit. Ask how often they drill on emergency procedures. A facility that takes this seriously will have specific answers, not vague assurances.
5. What’s your approach to medication management?
Medication errors in nursing homes are alarmingly common. Studies estimate that 5 to 40% of nursing home residents experience at least one medication error per month. Ask how medications are stored, distributed, and tracked. Is there a pharmacist who reviews each resident’s medications regularly? How do they handle new prescriptions and dosage changes?
Also ask about their policy on antipsychotic medications. Overuse of antipsychotics as chemical restraints (to sedate “difficult” residents rather than treat a diagnosed condition) is a documented problem in long-term care. A quality facility will have a low antipsychotic use rate and a clear policy on when these drugs are appropriate.
Daily Life and Activities
6. What does a typical day look like for residents?
A good nursing home isn’t just a place to receive medical care. It’s where your loved one lives. Ask for a copy of the daily schedule. Is there structure? Are there choices? Can residents sleep in if they want, or is everyone on the same rigid timetable?
Look for a balance of organized activities and personal freedom. Residents who sit in their rooms all day with nothing to do deteriorate faster, physically and mentally. You want to see a facility where people are out of their rooms, engaged, and interacting.
7. What activities and social programs do you offer?
A weekly bingo game isn’t enough. Quality activity programs include physical exercise, music therapy, art classes, gardening, outings, games, religious services, and intellectually stimulating programs. For residents with dementia, look for sensory activities, reminiscence therapy, and programs designed for different stages of cognitive decline.
Ask to see a recent month’s activity calendar. Is it varied? Is it realistic (not just a list that looks good on paper but gets cancelled half the time)? Talk to an activities director if you can. Their enthusiasm (or lack of it) tells you a lot.
8. How are meals handled, and can I see a menu?
Food matters enormously for quality of life and health. Ask to see a current menu and, if possible, eat a meal during your visit. Is the food prepared on-site or delivered from a central kitchen? Are meals served at set times only, or is there flexibility? What accommodations are made for dietary restrictions, allergies, and cultural preferences?
Also ask about assistance. If your loved one needs help eating, who provides it? Is there enough staff at mealtimes to help everyone who needs it, or are trays taken away before residents can finish?
Safety and Living Environment
9. What security measures are in place, especially for residents with dementia?
Wandering is one of the most dangerous risks for dementia patients. Ask about locked units, door alarms, wander-guard bracelets, and monitoring systems. How often do elopement incidents occur, and what happened afterward?
For non-dementia residents, ask about general safety: fall prevention programs, handrails, adequate lighting, non-slip flooring, and call button response times. How quickly does staff respond when a resident presses the call button? The answer should be minutes, not “when someone gets around to it.”
Regardless of the facility’s safety measures, non-slip socks with grips are a simple, inexpensive way to reduce fall risk. They’re especially helpful on tile and linoleum floors, which most nursing homes have.
10. What does a typical room look like, and can residents personalize their space?
Ask to see an actual occupied room (with the resident’s permission), not just the model room. Check for cleanliness, natural light, storage space, and accessibility. Is there room for a wheelchair to maneuver? Is the bathroom equipped with grab bars and an accessible shower?
Personalization matters for dignity and comfort. Can residents bring furniture, photos, bedding, and small personal items? Some facilities are strict about this for safety or space reasons. Others encourage it. Your loved one’s sense of home shouldn’t disappear entirely when they move in.
One practical tip: bring personal labeling supplies for all clothing and personal items. Items go missing in shared laundry systems, and labeling everything from day one prevents a lot of frustration.
11. How do you handle complaints and grievances?
Every facility will tell you they “take complaints seriously.” Press for specifics. Is there a formal grievance process? Who do complaints go to? How quickly are they addressed? Is there a resident council or family council that advocates for residents?
Ask whether the facility has had any substantiated complaints filed with the state ombudsman. You can also check this independently through your state’s long-term care ombudsman program.
Medical Care and Special Needs
12. What on-site medical services do you provide?
Beyond basic nursing care, find out what’s available on-site: physician visits (how often?), physical therapy, occupational therapy, speech therapy, dental care, podiatry, mental health services, and pharmacy. The more that’s available on-site, the fewer disruptive trips your loved one needs to make to outside appointments.
Ask about specialty care for specific conditions: dialysis, wound care, IV therapy, ventilator management, or behavioral health. If your loved one’s needs change over time, can the facility adapt, or will they need to transfer?
13. How do you create and update individual care plans?
Every resident should have an individualized care plan developed within the first few weeks of admission, then updated regularly. This plan should reflect their medical needs, personal preferences, goals, and daily routine.
Ask how often care plans are reviewed (quarterly is standard, more often if conditions change), who participates in the review (the resident, family, nursing staff, physician, therapists), and whether family members can attend and contribute. If care plan meetings happen without family input, the facility isn’t treating you as a partner.
14. Do you have a specialized memory care unit?
If your loved one has Alzheimer’s or another form of dementia, a dedicated memory care unit provides a higher level of supervision, specialized programming, and staff trained in dementia care. Not all nursing homes have memory care units, and those that do vary widely in quality.
Ask about the unit’s security features, staff training requirements (how many hours of dementia-specific training?), the types of activities offered, and how they handle behavioral symptoms like agitation, sundowning, and aggression. A facility that relies primarily on medication to manage behaviors rather than person-centered approaches should give you pause.
Visiting and Communication
15. What are your visiting hours and policies?
Open visiting hours are a sign of a confident, transparent facility. Restricted visiting hours (especially limited to a few hours per day) can indicate that the facility doesn’t want families seeing what happens during off-peak times.
Post-pandemic, some facilities still have lingering restrictions. Ask for the current policy in writing. Also ask about policies for different situations: can you visit during meals? Can children and pets visit? What happens during flu season or an outbreak? Being informed prevents frustration later.
16. How do you communicate with families about their loved one’s care?
Communication breakdowns are one of the most common family complaints about nursing homes. Ask specifically: How will you be notified if your loved one falls, gets sick, has a medication change, or experiences a decline? Is there a primary contact person? Can you access medical records and care updates through a portal or app?
The best facilities are proactive communicators. They don’t wait for you to call and ask. They reach out when something changes, even if it’s minor. If a facility tells you they’ll “call if there’s a problem,” ask them to define what qualifies as a problem.
Costs and Financial Questions
17. What is the total monthly cost, and what’s included versus extra?
Nursing home costs are staggering, and the base rate rarely covers everything. The national median cost for a semi-private room is approximately $8,000 to $9,500 per month. Private rooms run $9,500 to $12,000+. These numbers vary significantly by state and region.
Get a complete breakdown: What does the base rate include? What costs extra? Common add-ons include prescription medications, personal care supplies (incontinence products, specialty toiletries), telephone and cable, laundry service, beauty shop visits, and certain therapies. These extras can add $500 to $1,500 per month on top of the base rate.
Ask for the fee schedule in writing. Ask about rate increases: how often do they happen, how much notice do you get, and what’s the typical annual increase? Most facilities raise rates 3 to 5% annually.
18. Do you accept Medicare and Medicaid, and what happens when private funds run out?
This is a critical financial planning question. Medicare covers skilled nursing facility care for up to 100 days following a qualifying hospital stay (3+ days). After that, residents must pay privately, use long-term care insurance, or qualify for Medicaid.
Many families pay privately until funds are depleted, then transition to Medicaid. Not all nursing homes accept Medicaid, and some that do have a limited number of Medicaid beds. Ask directly: “If my loved one starts as a private-pay resident and later needs to transition to Medicaid, will you keep them?” Get this commitment in writing if possible.
What to Bring to Your Visit
Come prepared to evaluate each facility thoroughly.
- This printed checklist with space for notes. You’ll visit multiple facilities and the details blur together fast. Write down answers at each stop so you can compare later.
- Your loved one’s current medication list. The facility needs to confirm they can manage all current medications and any specialized administration needs (insulin injections, nebulizers, etc.).
- Insurance information and financial documents. Medicare card, Medicaid eligibility documentation, long-term care insurance policy, and a summary of available financial resources. The admissions coordinator will need these to discuss costs and coverage.
- A list of your loved one’s care needs and preferences. Dietary requirements, mobility limitations, cognitive status, social preferences, religious needs, and daily routine. The more specific you are, the better the facility can assess whether they’re a good match.
- Contact information for your loved one’s current doctors. Primary care physician, specialists, and any therapists. The facility will need to coordinate care transitions.
- A camera or phone for photos. Document rooms, common areas, hallways, and posted information (menus, activity calendars, staffing charts). Photos help you compare facilities later and share information with family members who couldn’t visit.
Typical Cost Range and Factors
Long-term care costs are among the largest expenses families face. Here’s a realistic breakdown for 2026.
Semi-Private Room (shared): $7,500 to $9,500 per month nationally. Higher in states like Connecticut, Massachusetts, and New York ($10,000 to $14,000+). Lower in states like Oklahoma, Missouri, and Texas ($5,500 to $7,500).
Private Room: $9,000 to $12,000+ per month nationally. Premium facilities in high-cost areas can exceed $15,000 per month.
Memory Care Unit (add-on): Adds $1,000 to $3,000 per month on top of the base rate for the specialized staffing, programming, and security involved.
Medicare Coverage (skilled nursing): Days 1 through 20 are covered at 100% (after a qualifying hospital stay). Days 21 through 100 require a daily copay of approximately $204.50 per day in 2026. After day 100, Medicare coverage ends entirely.
Medicaid Coverage: Covers nursing home care for eligible residents with limited income and assets. Eligibility rules vary by state. The application process is complicated, often requiring documentation of 5 years of financial history (the “look-back period”).
Long-Term Care Insurance: Coverage varies widely by policy. Typical daily benefit amounts range from $100 to $350 per day, with benefit periods of 2 to 5 years. Review the policy carefully for elimination periods (the waiting period before benefits kick in, usually 30 to 90 days).
What Drives Costs Up: Private rooms, memory care units, high-cost geographic areas, specialized medical needs (ventilator care, dialysis), and add-on services not included in the base rate.
What Drives Costs Down: Semi-private rooms, Medicaid coverage, VA benefits for eligible veterans, states with lower costs of living, and negotiating the base rate (yes, this is sometimes possible, especially when the facility has vacancies).
Red Flags vs. Green Flags
| Red Flag | Green Flag |
|---|---|
| Strong, persistent odors of urine or cleaning chemicals. Odors indicate understaffing and poor hygiene practices. | Clean, fresh-smelling environment throughout the facility, not just in common areas. |
| Residents sitting unattended in wheelchairs or lying in bed during daytime hours with no engagement. | Residents are out of their rooms, participating in activities, and interacting with each other and staff. |
| Staff seem rushed, overwhelmed, or unresponsive to resident requests. Call buttons go unanswered for long periods. | Staff are attentive, calm, and interact with residents by name. Call buttons are answered within minutes. |
| The facility discourages unannounced visits or limits visiting hours significantly. | Open visiting hours and a welcoming attitude toward family presence at any time. |
| High staff turnover or frequent use of agency (temp) nurses and CNAs. | Stable, consistent staff who know residents by name and are familiar with their care needs. |
| Multiple serious deficiencies on state inspection reports (check Medicare.gov). | Strong inspection history with no serious deficiencies, or deficiencies that were promptly corrected. |
| Vague answers about costs, or surprise charges showing up on bills. | Transparent, written fee schedule provided upfront, with clear explanations of what is and isn’t included. |
| The facility won’t let you talk to current residents or their families. | Families and residents speak positively about the facility, and staff encourage you to talk to them. |
Money-Saving Tips
- Apply for Medicaid early. The application process can take 45 to 90 days (longer in some states). Start the paperwork as soon as you anticipate needing Medicaid coverage. An elder law attorney can help navigate the process and avoid costly mistakes.
- Explore VA benefits if your loved one is a veteran. The VA Aid and Attendance benefit can provide up to $2,431 per month (2026) for qualifying veterans who need nursing home care. Surviving spouses may also qualify. Contact your local VA office or a VA-accredited claims agent.
- Negotiate the room rate. If the facility has empty beds, they may be willing to negotiate. This is more common with private-pay residents. Even a 5 to 10% reduction on a $10,000 monthly rate saves $6,000 to $12,000 per year.
- Choose a semi-private room. The cost difference between semi-private and private rooms is typically $1,500 to $3,000 per month. If your loved one is social or doesn’t have strong privacy preferences, the semi-private option offers significant savings.
- Review the bill monthly. Nursing home bills are complex and errors happen. Check for duplicate charges, services not received, and supplies billed at inflated prices. Dispute anything that doesn’t look right.
- Consult an elder law attorney before spending down assets. Medicaid planning is complex, and well-meaning families often make mistakes that cost thousands (like transferring assets during the look-back period). A one-time consultation ($300 to $500) can save you tens of thousands.
- Look into state programs and waivers. Many states offer home and community-based waiver programs that can delay or prevent nursing home placement. These programs provide services like home health aides, adult day care, and respite care at a fraction of nursing home costs.
- Use the Medicare skilled nursing benefit strategically. If your loved one has a qualifying hospital stay, the first 20 days of skilled nursing care are covered at 100%. Time major procedures or hospitalizations with awareness of this benefit.
Quick Reference Checklist
Print this and bring it to every facility visit.
Staffing and Care Quality
- What is the staff-to-resident ratio (day, evening, night)?
- What’s the staff turnover rate?
- Is an RN on-site 24/7?
- How are medical emergencies handled?
- How is medication managed and monitored?
Daily Life and Activities
- What does a typical day look like?
- What activities and social programs are available?
- What are meals like? (Ask to see a menu or eat a meal.)
Safety and Environment
- What security measures are in place for dementia residents?
- Can I see an actual resident room?
- How are complaints and grievances handled?
Medical Care
- What on-site medical services are available?
- How are individual care plans created and updated?
- Is there a specialized memory care unit?
Communication and Visiting
- What are the visiting hours and policies?
- How does the facility communicate with families?
Costs and Finances
- What is the total monthly cost, and what’s extra?
- Do you accept Medicare and Medicaid?
- What happens when private funds run out?
Glossary
Skilled Nursing Facility (SNF): A facility that provides 24-hour nursing care, rehabilitation services, and medically necessary care for people who need a higher level of support than assisted living can provide. Medicare covers skilled nursing care for limited periods after qualifying hospital stays. Medicaid covers long-term stays for eligible residents.
Activities of Daily Living (ADLs): The basic self-care tasks used to assess a person’s functional abilities: bathing, dressing, eating, toileting, transferring (moving from bed to chair), and continence management. The number of ADLs a person needs help with determines their level of care and, in many cases, their eligibility for benefits.
Look-Back Period: The period of time (typically 5 years) during which Medicaid reviews all financial transactions to identify any assets that were given away or transferred below market value. Transfers during this period can result in a penalty period of Medicaid ineligibility. This is why consulting an elder law attorney before making financial moves is critical.
Ombudsman: An independent advocate who investigates and resolves complaints on behalf of nursing home residents. Every state has a long-term care ombudsman program, and their services are free. They can help with care quality concerns, resident rights violations, and billing disputes. Contact your state’s ombudsman through the Eldercare Locator at 1-800-677-1116.
Person-Centered Care: An approach to care that treats residents as individuals with unique preferences, histories, and needs, rather than as a set of medical conditions to manage. It emphasizes choice, dignity, respect, and meaningful engagement. Facilities that practice person-centered care involve residents in their own care decisions and tailor daily routines to individual preferences.
Census: The number of residents currently living in a facility relative to its total capacity. A facility operating at very low census (below 70%) may be struggling financially, which can affect staffing and care quality. Very high census (above 95%) may mean less individual attention and longer wait times for services.
Helpful Tools and Resources
Label every piece of clothing and personal linen before move-in day. Items regularly go missing in shared laundry systems, and pre-labeled clothing is far easier to track down and return.
Falls are the number one safety risk in nursing homes. Grip socks with rubberized treads on both sides provide traction on tile and linoleum floors. Buy several pairs so there's always a clean pair available.
A familiar, cozy blanket from home provides comfort and a sense of normalcy. Institutional bedding is functional but impersonal. A personal blanket is one of the simplest ways to make a nursing home room feel less institutional.
- Medicare Care Compare (medicare.gov/care-compare) - Look up any nursing home’s star rating, health inspection results, staffing levels, and quality measures. This should be your first stop in evaluating any facility.
- Eldercare Locator (eldercare.acl.gov or 1-800-677-1116) - A national resource connecting older adults and caregivers with local services: ombudsman programs, transportation, legal assistance, and financial counseling. Operated by the U.S. Administration on Aging.
- National Academy of Elder Law Attorneys (naela.org) - Find an elder law attorney in your area who specializes in Medicaid planning, nursing home contracts, and long-term care legal issues.
- Family Caregiver Alliance (caregiver.org) - Practical resources for family caregivers, including state-by-state guides to long-term care options, financial planning tools, and caregiver support programs.
Frequently Asked Questions
How many nursing homes should I visit before making a decision?
Visit at least three if your timeline allows. Five is better. The differences between facilities become clearer when you have comparison points. If possible, visit each one twice: once on the scheduled tour and once unannounced at a different time of day. A facility that looks great at 10 AM on a Tuesday might tell a different story at 6 PM on a Saturday.
Can I move my loved one to a different facility if I’m not satisfied?
Yes. Residents and their families have the right to transfer to another facility at any time. The current facility is required to provide a discharge plan and transfer medical records. In practice, moving is stressful for the resident, so it’s better to choose carefully upfront. But staying in a bad facility is worse than the disruption of a move.
What’s the difference between a nursing home and an assisted living facility?
Assisted living provides help with daily activities (bathing, dressing, medication reminders) in a more independent, apartment-style setting. Nursing homes provide 24-hour skilled nursing care for people with complex medical needs. The line between the two has blurred somewhat, but nursing homes are designed for higher-acuity residents who need medical monitoring and hands-on clinical care throughout the day.
How can I tell if a facility is understaffed?
Look for these signs: call buttons going unanswered for more than 5 minutes, residents sitting in soiled clothing, meal trays left unattended, staff seeming constantly rushed or stressed, and a heavy reliance on agency (temp) staff. Also check the facility’s staffing data on Medicare.gov. The reported hours of care per resident per day should meet or exceed 4.1 hours total (all nursing staff combined).
What rights does my loved one have as a nursing home resident?
Federal law guarantees nursing home residents extensive rights, including: the right to be treated with dignity and respect, the right to participate in care planning, the right to manage their own finances (or have a designated representative), the right to privacy, the right to voice complaints without retaliation, the right to receive visitors, and the right to leave the facility. These rights are real and enforceable. If you believe they’re being violated, contact your state’s long-term care ombudsman.
Next Steps
Start by checking Medicare.gov for star ratings and inspection reports on facilities in your area. Eliminate any with serious recurring deficiencies. Then narrow your list to three to five facilities and schedule tours.
Bring this checklist to every visit. Take notes, take photos, and trust your instincts. Talk to staff, residents, and visiting family members. The feel of a place tells you things that the brochure won’t.
If time allows, involve your loved one in the decision. Visit together if possible. Their comfort and preferences should be central to the choice, not an afterthought.
This decision is hard. It’s supposed to be hard, because it matters that much. Do the work now, and you’ll have confidence later that you made the best possible choice with the information you had.