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A complete guide to nursing homes and assisted care facilities in the United States  
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By Judy Maloney, RN, BSN

February 2010

An on-site visit offers you the best opportunity to observe the residents, staff, and the quality of care provided by the facility. Here are some helpful hints to accomplish a meaningful and informative visit to assist with helping you to make the care choice that is right for you or your loved one. Try to be as prepared as possible before your tour, considering the immediate needs and the possible future health care needs to be met for the best quality of life.

There are many different types of facilities, each directed toward specific levels of care needs. These include Retirement Communities, Rehabilitation Centers, Nursing Homes, Hospices, Assisted Living, and Adult Day Care. For a list of care facilities in your area, see www.assistedcarefacilities.net


Ahead of time, discuss with your loved one, family and significant others, and the doctor what type and to what degree of care is needed. Consider lifestyle, physical, emotional and mental status, mobility/safety issues, dietary needs, medication management, spiritual, social and financial concerns. Check out each facility's website if available. Make a list of all questions that come up. Discuss Advance Directives, a legal document expressing the wishes of your loved one if they are unable to communicate at some later date. Other ideas to discuss are the need for Durable Power of Attorney for Health Care or Guardianship if appropriate, and who the main contact person would be to represent the family. Find and copy legal documents, such as social security card, birth certificate, driver's license, military records, and insurance information. Accumulate and organize as much personal and financial information as you can, and update it as needed, keeping it in a safe and accessible place for future reference.

Involve the person needing the care in the discussion and decisions, and give them the opportunity to tour the facility, to ask questions, and help select the final choice. This may help with their final adjustment to the new home.

Prepare a worksheet/checklist to evaluate the different facilities you are considering.

Call ahead for an appointment. Ask to meet w/ the administrator, social service director, and a nurse. Request to bring your loved one to tour the facility. Ask to eat a meal and/or observe an activity during your visit.


Be on time, and allow time for a thorough tour. Bring a list of questions with you and be prepared to write down more questions as they come up during the tour. Take notes as you tour, including initial reactions to what you see, hear, smell, like, or don't like. Observe interactions between staff and residents. Ask if they are satisfied with the facility and the services offered. Ask about qualifications of the administrator and staff.

Ask questions about anything you see or hear that you don't understand.

Talk with residents as you tour but don't go into resident rooms without permission. Ask if you can talk to families of residents in the places you are touring. Review their activity calendar, ask about outings, events, and transportation.

Get a list of services the facility provides, ask if they offer flexible/progressive care as needed, and what different levels of care they can accommodate. What is the criteria for asking a resident to leave if their level of care increases beyond what they can provide? Who makes this decision? Is the family consulted?

Ask to review their last licensing/certification report.

Discuss costs, including base rate and extra expenses to personalize the care, planned annual rate increases, as well as Long Term Care, Medicare and Medicaid coverage. Make sure you're talking to the appropriate staff member about financial issues. Don't be afraid to ASK questions!

Are there extra charges for services like incontinence care, transportation, laundry service, meals delivered to the room, or increasing personal care needs like feeding or special medical care?

How much privacy is available for residents and for family visits?

Do they offer private or semi-private rooms?

Ask about their emergency protocol and services.

Ask for a copy of the most recent state inspection survey. The state Ombudsman Program could help you interpret. If you find this isn't available or if it lists unexplained health or safety deficiencies, you probably shouldn't consider that facility.

Review the Resident Agreement of the facility.

Ask who to call if you have further questions after your tour & write down the contact information including phone number or email

If it appears to be a promising option, return to the facility at a later date, different time of day or evening, or during a meal or another activity.



Consider location, is it near enough for family and friends to visit? Is it close to a medical facility? How much supervision do they offer?

Consider distance to the dining area, activity rooms, & social rooms & ability to get there safely and easily. Ask about the safety and security system in the facility, access to personal alarm system, phone, call bell system in bathrooms and bedrooms.

What is their method of billing?

Do they have a "bed hold" policy if your loved one is in the hospital or out of the facility for a period of time?

Do they have resident/staff/family meetings on a regular basis? Who should attend? Is a family support group available?

What is their resident/staff ratio on each shift? Does a doctor or other medical provider visit regularly? Is a dentist or podiatrist available? Do they have their own pharmacy? Are residents required to use that pharmacy? Is physical therapy available?

Are there dedicated areas for opportunity to exercise, for a hair salon, TV or activity room? Is there a nurse on staff part time or 24/7? If not, who does the resident assessments and ensure the plan of care is implemented? How often are reassessments done? Who does medication dispensing, wound care, or other medical services?

What training, qualifications, and on-going training are required of the staff? Are they trained to deal with people with cognitive impairments? Are there any special services or activities for those with memory impairment or other disabilities?


Be prepared to give a history about the person including all doctors, pharmacist, allergies, any diet or religious restrictions or special needs. Their doctor may be able to provide a complete health history and medication list.

Physical-are they able to get around independently with or without devices? How much assistance do they need to walk, shower, dress, eat, get to the bathroom, find their way back to their room? Do they need physical therapy? Is there a history of falls? Are there any wounds? Are they incontinent of bowels or bladder? Is there a urine catheter or any other tubes that need attention? Do they use oxygen? Do they have poor hearing or vision? Would they be able to find a way to get outside in case of an emergency or fire without help? (This issue may a determining factor on qualification for assisted living vs. nursing home)

Mental/emotional-Are they aware of who they are & their surroundings, time, date? Do they have a sense of safety to avoid falls or other accidents? Will they accept help with mobility and other activities of daily living? Have they ever had a roommate in the past? Is there a history of fear problems in a new environment or around new people? Do they have any habits that may influence the choice of a roommate?

Are there any special routines, habits, practices, interests or lifestyle issues the facility needs to be aware of?


Making a change in the living situation may occur suddenly as a result of a crisis, such as a health status change or illness or death of a caregiver or loved one. Sometimes it's a gradual and evolving result of the aging process. Either way, it is often difficult for a family to talk about moving a loved one out of their current home and into a facility of some type. Be prepared to listen to each person's concerns, fears, and ideas. Ask questions, allowing everyone to express their view on the subject, and discuss alternatives and options. Feelings of guilt can occur, and it's important to talk about the goals of having good quality of life, living safely, and addressing current and future care needs. Having a social worker, lawyer, counselor, clergy, accountant, financial planner, or physician take part in the conversation can help with emotional or delicate issues and decisions that can be difficult for families to discuss.

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