How do I choose a Nursing Home?

Follow these 4 steps to find a nursing home that best meets your needs:

Step 1: Find nursing homes in your area.

Step 2: Compare the quality of the nursing homes you’re considering

Step 3: Visit the nursing homes you’re interested in, or have someone visit for you.

Step 4: Choose the nursing home that best meets your needs.

Step 1: Find nursing homes in your area.

There are many ways you can learn about nursing homes in your area:

• Ask people you trust, like your family, friends, or neighbors.
• Ask your doctor if he or she provides care at any local nursing homes. You may be able to get care from him or her while you’re in the nursing home.
• Visit Medicare.gov/nursinghomecompare.
• Use the Eldercare Locator or an Aging and Disability Resource Center (ADRC). Visit here.
• Contact your local senior and community activity center.
• If you’re in the hospital, ask your social worker about discharge planning as early in your hospital stay as possible. The hospital’s staff should be able to help you find a nursing home that meets your needs and help with your transfer when you’re ready to be discharged.

Step 2: Compare the quality of the nursing homes you’re considering.

Medicare’s Nursing Home Compare

Visit Medicare.gov/nursinghomecompare to get information on the quality of every Medicare- and Medicaid-certified nursing home in the country. Consider the information you find on Nursing Home Compare carefully. Use it, along with the other information you gather, to help guide your decision.

Information on Nursing Home Compare isn’t an endorsement or advertisement for any particular nursing home.

Use these resources to help you choose a nursing home:

• Call your Long-Term Care Ombudsman. Visit here.
• Call your state health department or state licensing agency. Look in the blue pages in the phone book or on the internet. Ask if they have written information on the quality of care given in local nursing homes. You can also ask for a copy of the full survey or the last complaint investigation report.
• Look at survey findings (CMS Form 2567) for the facility. They can be found on Nursing Home Compare at Medicare.gov/nursinghomecompare and in the nursing home.

Step 3: Visit the nursing homes you’re interested in, or have someone you trust visit for you.

After you consider what’s important to you in a nursing home, visit the nursing homes. It’s best to visit the nursing homes that interest you before you make a final decision on which one meets your needs.

A visit gives you the chance to see the residents, staff, and the nursing home setting. It also allows you to ask questions of the nursing home staff and talk with residents and their family members.

If you can’t visit the nursing home yourself, ask a family member or friend to visit for you. You can also call for information, but a visit can help you see the quality of care and life of the actual residents. For a checklist of things to look for when you visit a nursing home, visit here.

Important things to know when visiting nursing homes

• Before you go, call and make an appointment to meet with someone on the staff. You’re also encouraged to visit the nursing homes at other times without an appointment.
• Don’t be afraid to ask questions.
• Ask the staff to explain anything you see and hear that you don’t understand.
• Ask who to call if you have more questions, and write down their name and phone number.
• If a resident or a resident’s family wishes, you may talk to them about the care offered at the facility and their experience.
• Don’t go into resident rooms or care areas without asking the resident and nursing home staff first. Always knock first and ask a resident before entering their room. Residents have a right to privacy and can refuse to allow you to come into their rooms.
• After your visit, write down any questions you still have about the nursing home or how the nursing home will meet your needs.

Here are some general things to consider when you visit a nursing home:

• • How does the nursing home help you to participate in social, recreational, religious, or cultural activities that are important to you?
  • Is transportation provided to community activities?
  • What kind of private spaces does the nursing home offer for when you have visitors?
  • Who are the doctors that will care for you? Can you still see your personal doctors? If your personal doctors don’t visit the nursing home, who will help you arrange transportation if you choose to continue to see them?
  • What does the quality of care and staffing information on Nursing Home Compare at Medicare.gov/nursinghomecompare show about how well this nursing home cares for its residents?
  • Will the same nursing home staff take care of you day-to-day, or do they change?
  • How many residents is a Certified Nursing Assistant (CNA) assigned to work with during each shift (day and night) and during meals?
  • What type of therapy is available at this facility? Are therapy staff available?
  • What types of meals does the nursing home serve?
    Note: Ask the nursing home if you can see a menu.
  • How will the nursing home make sure that your dietary needs are met?
  • Does the nursing home make sure residents get preventive care to help keep them healthy? Are specialists like eye doctors, ear doctors, dentists, and podiatrists (foot doctors) available to see residents on a regular basis? Does the facility help make arrangements to see these specialists?
    Note: Nursing homes must either provide treatment or help you make appointments and arrange transportation for you to see specialists.
  • Does the nursing home have a screening program for vaccinations, like flu (influenza) and pneumonia?
    Note: Nursing homes are required to provide flu shots each year, but you have the right to refuse if you don’t want the shot, have already been immunized during the immunization period, or if the shots   are medically contraindicated.
  • How will you get access to oral care in the nursing home?
  • How will you get access to mental health care in the nursing home?
  • Does the nursing home offer care for people with dementia? What care does it offer?
  • What’s the nursing home’s policy for the use of anti psychotic medication for people with dementia?

  Use the “Nursing home checklist” when you visit a nursing home Take a copy of the “Nursing home checklist” pages when you visit to help you evaluate the quality of a nursing home. Use a new checklist for each nursing home you visit. You can photocopy the checklist or print more copies at Medicare.gov/files/nursing-home-checklist.pdf.

  Step 4: Choose the nursing home that meets your needs.

  When you have all the information that’s important to you about the nursing homes you’re considering, talk with people who understand your personal and health care needs. This can include your family, friends, doctor, clergy, spiritual advisor, hospital discharge planner, or social worker.

  What if more than one nursing home meets my needs?

  If you find more than one nursing home you like with a bed available, use the information you gathered to compare them. If you don’t like what you saw on a visit (for example, if the facility wasn’t clean or you weren’t comfortable talking with the nursing home staff), you may want to choose another nursing home. If you felt that the residents were treated well, the facility was clean, and the staff was helpful, you might feel better about choosing that nursing home.

  What if I’m helping someone make a decision?

  If you’re helping someone, keep the person you’re helping involved in the decision making process as much as possible. People who are involved from the beginning are better prepared when they move into a nursing home. If the person you’re helping isn’t alert or able to communicate well, keep his or her values and preferences in mind.

  What if I don’t like a nursing home I visit?

  If you visit a nursing home that you don’t like, look at other options, if available. Your happiness and the quality of your care is important.

  What if I’m in the hospital and don’t like the nursing home that has an available bed?

  If you’re in a hospital and decide not to go to a certain nursing home that has an available bed, talk to the hospital discharge planner or your doctor. They may be able to help you find a more suitable nursing home or arrange for other care, like short-term home health care, until a bed is available at another nursing home you choose. But you may be responsible for paying the bill for any additional days you stay in the hospital.

  Next steps: After you’ve chosen a nursing home

  After you choose a nursing home, you’ll need to make arrangements to be admitted. Have this information ready when you contact the nursing home:

  Information for the nursing home office staff

  • • Insurance information: Provide information about any health coverage and long-term care insurance you have that pays for nursing home care, health care, or both. This includes the name of the insurance company and the policy number.
      Note: If Medicare or Medicaid will cover your nursing home care, the nursing home can’t require you to pay a cash deposit. They may ask that you pay your Medicare coinsurance and other charges you would normally have to pay. The nursing home can’t require you to pay more than the rates allowed by Medicare or Medicaid for covered services. There may be charges for items or services that Medicare or Medicaid don’t cover, but the nursing home can’t require that you accept services that Medicare or Medicaid don’t cover as a condition of your continued stay.
      It’s best to pay charges once they’re billed to you – not in advance. You may have to pay a cash deposit before you’re admitted to a nursing home, if your care won’t be covered by either Medicare or Medicaid, and the nursing home isn’t limited to the rates allowed by Medicare or Medicaid.

  Information for the nursing home medical staff

• Your medical history: Your doctor may give the staff some of this information. This includes a list of past health problems, any past surgeries or treatments, any shots you’ve had, and allergies you may have to food or medicine.
• Your current health status: Your doctor should give the staff this information, including a list of your current health problems, recent diagnostic test results, and information about any activities of daily living that might be difficult for you to do by yourself.
• Your current medications: Include the dose, how often you take it, and when and why you take it.
• Your health care providers: Include their names, addresses, and phone numbers.
• Your family members to call in case of an emergency: Include their names, addresses, and phone numbers.

Other important information to have ready Health care advance directives

You may be asked if you have a health care advance directive, which is a written legal document that says how you want medical decisions to be made if you become unable to make decisions for yourself. There are 2 common types of health care advance directives:

• A living will: A written legal document that shows what type of treatments you want or don’t want in case you can’t speak for yourself, like whether you want life support. Usually, this document only comes into effect if you’re unconscious.
• A durable power of attorney for health care: A legal document that names someone else to make health care decisions for you. This is helpful if you become unable to make your own decisions.

If you don’t have a health care advance directive and need help preparing one, or you need more information, talk to a social worker, discharge planner, your doctor, or the nursing home staff. You can use the Eldercare Locator to find out if your state has any legal services that can help you prepare these forms. Visit here.

Once you’re a resident

Information the nursing home must give you

Once you choose a nursing home, they must give you information about how to apply for and use Medicare and Medicaid benefits in a language and format you understand. They must also give you information on how to get refunds for previous payments you may have made that are covered by these benefits.

Personal needs accounts

You may want to open an account managed by the nursing home, although the nursing home can’t require this. You can deposit money into the account for personal use. Check with the nursing home to find out what expenses you can use the account for and how they manage the accounts.

Your assessment & care plan

Once you’ve selected a nursing home and are a resident, the nursing home staff will get your health information and review your health condition to prepare your care plan. You (if you’re able), your family (with your permission), or someone acting on your behalf has the right to take part in planning your care with the nursing home staff.

Your assessment begins on the day you’re admitted and must be completed within 14 days. Staff will gather information about how well you function, your care needs, and your general well-being. The nursing home staff will review your assessment at least every 90 days, and possibly more often if your medical status changes.

Once your assessment is complete, the nursing home staff will develop your care plan. Your care plan is a strategy for how the staff will help you with everyday needs – both medical and non-medical.

Depending on your needs, your care plan may include:

• What kind of personal or health care services you need
• What type of staff should give you these services
• How often you need the services
• What kind of equipment or supplies you need (like a wheelchair or feeding tube)
• Activity preferences
• Your food preferences and dietary needs
• How your care plan will help you reach your goals
• Information on whether you plan to return to the community and, if so, a plan to help you meet that goal. For more information, visit Medicare.gov/publications to download and view these products:
  • “Your Discharge Planning Checklist”
  • “Your Right to Get Information about Returning to the Community”

Your resident rights & protections

As a resident in a Medicare- and/or Medicaid-certified nursing home, you have certain rights and protections under federal and state law to make sure you get the care and services you need. You have the right to be informed, make your own decisions, and have your personal information kept private.

The nursing home must communicate these rights to you in a format and language you understand. They must also explain in writing your rights and responsibilities while you’re in the nursing home. This must be done before or at the time you’re admitted, as well as during your stay. You must acknowledge in writing that you got this information.

Here’s a list of some of your rights:

• Be free from discrimination.
• Be free from abuse and neglect.
• Exercise your rights as a U.S. citizen.
• Have your representative notified about your care.
• Get proper medical care.
• Be treated with respect.
• Be free from restraints.
• Have protections against involuntary transfer or discharge.
• Participate in activities.
• Spend time with visitors.
• Form or participate in resident groups.
• Manage your money.
• Get information on services and fees.
• Get proper privacy, property, and living arrangements.
• Make complaints.

For a full list of your resident rights and protections, visit Medicare.gov.

Reporting & resolving problems

If you have a problem at the nursing home, talk to the staff involved. For example, if you have a problem with your care, talk to the nurse or Certified Nurse Assistant (CNA). The staff may not know there’s a problem unless you tell them. If the problem isn’t resolved, ask to talk with the supervisor, social worker, director of nursing, administrator, or your doctor.

If your problem continues, follow the facility’s grievance procedure for complaints. The Medicare- and/or Medicaid-certified nursing home must have a grievance procedure. You may also want to bring the problem to the resident or family group.

A Medicare- and/or Medicaid-certified nursing home must post the name, address, and phone number of groups that may be helpful to you, like the State Survey Agency, State Licensure Office, State Long-Term Care Ombudsman Program, Protection and Advocacy Agency, and the Medicaid Fraud Control Unit. If you feel you need outside help to resolve your problem, call the Long-Term Care Ombudsman, State Survey Agency, or the Protection and Advocacy Agency for your area.

To get the contact information for these resources in your state, visit Medicare.gov/contacts or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

What if I don’t like a nursing home I’m currently in?

If you don’t like the nursing home you’re currently living in, you can move to another facility with an available bed. Moving can be difficult, but an extra move may be better for you than choosing to stay at a facility that isn’t right for you.

The nursing home you leave may require that you let them know ahead of time that you’re planning to leave. Talk to the nursing home staff about their rules for leaving. If you don’t follow the rules for leaving, you may have to pay extra fees.

If you want information about living in the community, nursing homes are required to reach out to a local agency that can give you more information. Talk to the nursing home social worker about your plan to transition to the community.