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How to Choose the Best Nursing Home for Your Parents

Family choosing nursing home.

Uncle Sam wants families to check federal government ratings on nursing home quality before signing on the bottom line on behalf of an elderly family member.

But that’s not happening as consumers say they don’t know where to look to find those ratings, even as nursing home care performance problems continue to grow.

So how do you find government ratings on nursing homes, and how can you leverage the information you find to choose the best senior care facility? Start with Medicare’s new Five-Star Quality Rating System and go from there.

The U.S. Center for Medicare and Medicaid Services rolled out its new rating system in April, 2019, with the goal to help families compare local nursing homes and get key questions answered.

In a nutshell, the CMS’s Nursing Home Compare Website rates nursing homes on a scale of 1 to 5 start, with five stars signaling a top-flight nursing home and one star meaning the senior care facility is below standard performance levels.

More specifically, the new rating system ranks nursing homes in three key areas: health inspections, staffing and quality measures.

Ranking the best nursing homes

Here’s a closer look at what the CMS is doing to rank nursing homes in all three areas:

Health inspections. The CMS sends in its own inspectors to rank nursing homes for health inspection criteria, special focusing on minimum quality requirements. The actual five star rating system covers the three most recent CMS nursing home inspections. More emphasis is on the most recent senior care investigations, but the agency does factor in prior years ratings, as well.

Staffing levels. CMS investigators also close in on the number of hours nursing home health professionals are in the senior care facility and on the clock. A key factor in the “hours on staff” determination is the estimated need nursing home residents have for nurses and staffers. The higher the need for good medical care professionals the more hours a nursing home must have for staffing needs.

Quality measures. Quality is measured by CMS investigators in 17 key areas, mainly focusing on the actual physical and clinical needs of nursing home residents. For example, a CMS investigation team will likely focus on occupational and/or speech therapy for residents recovering from an injury or an illness.

Or, a rating model will focus both on nursing home residents who are receiving short-term rehab sessions and on residents who need more regular, longer-care attention, as they’re less likely to live on their own independently.

Vetting Senior Care Centers

With the ratings parameters in place, now it’s up to consumers and advocacy groups to do their own vetting of a senior care facility. And even with Uncle Sam’s rating formulas in place, that’s not an easy job — but it is doable.

nursing home wheelchair

Use these tips when you’re in the nursing home selection process:

Ask an expert. Don’t pick a home without talking to a senior care living expert – preferably one close to the home.

“The one issue we cannot stress enough, that most people don’t even know about, is to seek guidance from a local senior living expert,” says to Arthur Bretschneider, CEO and founder of, the fastest growing senior living marketplace in the U.S.  “They know everything about all the communities, the staff, other residents.

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"Simply put, they are the best resource for families to learn the most candid information about local senior living options. Better yet, their services are usually free, as they are compensated by the community eventually selected.”

Base your selection process on the home attendee – not your own criteria. One of the worst mistakes one could make when searching for any kind of assisted living facility for a family member or loved one is to choose based on their own preferences rather than the individual who will be moving into the facility.

“Make sure to keep your loved one updated with all the information you find, and make sure they’re included in every discussion and the final decision,” says Sandy Griffin, nurse and quality assurance coordinator  at the Hospice of South Louisiana, Louisiana's longest running hospice facility. “If possible, bring them along with you on your searches so they can get a better idea of where they want to stay.”

Check for cleanliness. Emphasizing cleanliness will tell you a lot about the facility you’re touring. “If they seem to be lacking in cleanliness, chances are they’re cutting corners elsewhere, too,” Griffin says. “This is especially dangerous in a facility that houses people with fragile health as they’re more susceptible to illness.”

Check to see what kinds of activities they offer. When you or your family don’t have much time to visit, it’s important to know that your loved one is enjoying themselves and is stimulated. “If they don’t have a plethora of events or activities for the residents, consider looking somewhere else,” Griffin says.

Ask plenty of questions and make sure the facility is equipped for your loved one’s needs. “Check the handrail height, shelf height, restroom handles, access to elevators, and navigability of the hallways,” Griffin adds. “Ask questions about the staff and their qualifications. Make sure they’re ready for any eventuality.”

Visit during a meal.  Does the food smell good?  Is it appetizing?  Do residents have a good experience in the dining room?  “You’ll want to know how your loved one will be treated, meal-wise,” says  Linda Hudwalker Bowman, chief communications officer at Western Home Communities, in Cedar Falls, Iowa.

Can your loved one lead a free, spontaneous life at the home? “Will they want the resident to follow a staff-driven schedule, or will your loved one be able to get up and go to bed when he/she feels like it, ask for what they want to eat, do things they enjoy?” asks Bowman. “The most progressive organizations follow small house models that promote dignity, purpose and spontaneity.”  

Ask about ownership. Is the nursing home a for-profit or non-profit company?  Do they have long-time administrators or is it a revolving door?  What's the organization's reputation in the greater community? Have they won any local contests such as Best of the Best? “Ask specifically if the senior care center has won any “Great Places to Work/Top Workplaces contests”, which are based on employee surveys,” Bowman advises.

Be realistic. Know that no nursing home is perfect, but there are good ones full of good people who truly care for the residents and want to help them live their best lives. 

As Bowman puts it, “you can find a good one if you spend some time looking for one."