Nursing home selection requires time and research

nursing home photoPhoto © St. Paul's Towers, Oakland, Calif.

The specter of physical, mental, emotional or sexual abuse occurring to your loved one in a nursing home is frightening. Large government or university public health studies have reported that as many as 1 in 3 nursing home residents suffer abuse. Many cases are not properly investigated or reported. Residents who are female, have trouble communicating, are not independently mobile, and who do not have a loved one or other advocate diligently watching over their care are most likely to be abused. The abuser may be a staff member, or another resident who is not supervised properly by staff.

Even in nursing homes where abuse is not a problem, poor-quality care may be an issue. Residents may not be properly bathed, fed, or dressed. Those confined to bed may not be rotated frequently enough to prevent bedsores. Social activities may be lacking. Medication may not be given correctly. Illnesses might not be treated quickly enough to avoid complications. Because nursing home residents may have trouble with communication or memory, it can be hard to tell if your loved one is receiving poor care.

No one wants their loved one to suffer from poor-quality care, or worse, abuse. But when it comes to nursing home care, it truly is a case of “buyer beware”!

Do your homework

The most important step in choosing a nursing home is to do your homework. Investigate the available options both online and in person. Do not rely completely on a recommendation given by a hospital or clinic, even if you are feeling rushed. Often, your loved one is ready to be discharged from the hospital but is unable to return to their prior living situation. You might feel that accepting an available facility with an open bed that is on a list provided by the hospital is an easy and reliable solution. However, not all facilities are created equal. Sometimes, a facility that is owned by the same company as a hospital may be at the top of the list, even if it is not the highest-rated facility in the area.

Use online Medicare nursing home ratings

The good news is that finding information online about nursing home quality is easier than ever. The Centers for Medicare & Medicaid Services (CMS) collects a large quantity of information about nursing homes across the country. Each facility is inspected and then rated in three categories: health and safety; staffing; and quality of resident care. A rating between 1 star (worst) and 5 stars (best) is given in each category, and an overall score is also given.

Health and safety rating

This score is calculated according to 180 health and safety standards set by the government. Examples include:

  • Hiring enough quality staff to provide adequate care;
  • Managing medications properly;
  • Protecting residents from physical and mental abuse;
  • Storing and preparing food properly; and
  • Ensuring fire safety measures are up to code

Staffing rating

This rating is calculated by how many hours every type of staff member is on duty each day or each week. Staff categories include:

  • Registered nurse (RN);
  • Licensed practical nurse or licensed vocational nurse (LPN/LVN);
  • Certified nursing assistant (CNA); and
  • Physical therapist (PT)

Quality of resident care rating

This score is based on dozens of measures about how well residents are doing. These include measures such as the percent of residents who:

  • Experience falls;
  • Contract urinary tract infections;
  • Experience unexpected loss of bowel/bladder control;
  • Report symptoms and signs of depression;
  • Develop bedsores or pressure ulcers;
  • Report uncontrolled pain or severe pain;
  • Receive proper vaccinations for the flue or other diseases; and
  • Receive prompt medical care for health concerns

To make it easier to compare nursing homes in your area, you can search our online database by entering the name of the facility you are looking into. For each facility, you can see more information, location and contact details, photos, and detailed CMS star rating information presented in a user-friendly interface.

Visit the nursing home in person

Once you have narrowed down your options through online research, it is very important to visit each nursing home in person. It is a good idea to visit your favorite options at least twice, at two different days of the week and two different times of day. Here are some questions to ask as you look around:

  • Are the residents clean, well groomed, and appropriately dressed for the temperature?
  • Does the facility have an overwhelming bad odor?
  • Is the food well prepared and appealing?
  • Is there adequate lighting?
  • Is the noise level in the facility comfortable?
  • Can residents go outside?
  • What activities are available? Are there options even for residents who cannot leave their beds?
  • Do the staff members address residents by name rather than nicknames like “mama” or “grandpa”?
  • Do the staff often work double shifts/overtime, or does the facility have a high staff turnover? (Both of these are bad signs)
  • What measures are in place to prevent staff-to-resident or resident-to-resident abuse?
  • How are falls handled at the facility?
  • How are residents’ medical problems handled at the facility? Are residents allowed to see their own doctors?
  • Did the facility have any deficiencies (failure to meet one or more state or federal requirements) on its last inspection report? If so, how and when were they corrected?

Further resources about questions to ask when visiting a nursing home can be found in Medicare’s Nursing Home Checklist.

By doing your homework, investigating options, and visiting in person, you will be ready to select the best nursing home facility for your loved one.

Further Reading

AARP. Choosing the Right Nursing Home.

Centers for Medicare & Medicaid Services. Your Guide for Choosing a Nursing Home or Other Long-Term Services & Supports. The Nursing Home Checklist.


Lachs MS, Teresi JA, Ramirez M, et al. The prevalence of resident-to-resident elder mistreatment in nursing homes. Ann Intern Med. 2016;165(4):229-36.

Malmedal W, Iversen MH, Kilvik A. Sexual abuse of older nursing home residents: a literature review. Nurs Res Pract. 2015;2015:902515.

Schiamberg LB, Oehmke J, Zhang Z, et al. Physical abuse of older adults in nursing homes: a random sample survey of adults with an elderly family member in a nursing home. J Elder Abuse Negl. 2012;24(1):65-83.

About the Author

Jillian Lokere
Jillian is a science/medical writer who specializes in communicating complex scientific and medical ideas in a meaningful and engaging way. She holds a master's degree in biomedical science from Harvard University and a bachelor's degree in biological science from Stanford University. In addition, Jillian conducted two years of doctoral-level research in the Department of Genetics as part of Harvard's Biological and Biomedical Sciences program. She has more than 13 years of experience in writing about the life sciences and medicine.