Comprehensive Guide: Selecting the Best Care Facility for You or Your Loved Ones

Once you know your healthcare options, you need to visit in each facility in person. Before the visit, read this guide first and highlight the most important sections to pay attention to for your situation. Also, make a list of your specific needs and keep them in mind because they have the most relevance when deciding which facility is best for you.

Beware! How Hospitals and Providers Work Together

Hospitals, referral agencies, and insurance companies strongly influence which nursing homes and assisted living facilities patients are sent to after hospital stays. Rather than relying strictly on quality metrics, many admissions are driven by existing contracts, personal relationships, or network agreements. Insurance companies often prioritize facilities based on cost control rather than patient preference, and referral companies may recommend only those providers who pay commissions. This creates real risk: families may be steered toward facilities based on business arrangements, not objective measures like staffing ratios, patient outcomes, or regulatory history.

Read this guide BEFORE your tour so you are prepared for what to look for and which questions to ask. Remember to take notes 

First Impressions: What to Watch For

The lobby may look impressive, but don't let it shape your entire opinion. Facilities often invest heavily in lobbies and short-term rehab areas because that’s where they generate the most revenue. Pay attention to your five senses: Is the greeting warm? Are surfaces clean and freshly maintained? Watch for red flags like peeling tape, clutter, or trip hazards. Even if you're considering short-term care, always ask to tour the long-term care units — they reveal how a facility truly treats its patients and long-term residents day to day.

If you see residents in the lobby area, walk up to them and chat. These few minutes offer you a rare opportunity to get feedback. What to ask the residents:

1.     How long have they been living in the nursing home?

2.     Things they like/dislike?

3.     How well does the facility respond when things go wrong?

Trust Your Instincts — and the Families Who Know

Residents may express frustration simply because they don’t want to be in a care home — and that’s understandable. But if you see a visiting family member, ask their opinion: Are they satisfied with the care their loved one receives? Families often provide the most honest insight into the quality of a facility.

While appearances matter, your intuition is just as important. Pay attention to what your gut is telling you. Ask questions that aren’t on the checklist. Watch the staff’s eyes, their tone, and how they interact with residents. Are they sincere and caring, or just going through the motions? Don’t settle for “good enough.” You know your loved one best — trust your instincts and take time to find the right fit.

The Tour

While you wait for the tour, or at the beginning of the tour, check out the state inspection report that is hanging on the wall in the lobby. Each state requires the reports be visible to everyone. If you cannot find it, ask where it's hanging. And if you have questions about it, speak up and ask before the tour starts. Pay attention to the violations listed in the report. Have them walk you through their state inspection report and ask about their deficiencies and how they have responded to them. Ask them if their admissions have ever been halted due to immediate jeopardy or sub-standard care. Sometimes state surveys are completed, and the Medicare 5-Star rating isn’t yet updated. Ask about substantiated abuse events and how they prevent and handle alleged abuse.

You'll be given a tour by either the director of admissions, a director of nursing or a marketing representative. The tour follows a planned and fixed route. Don’t let them steer you away from this document. There will be areas they will not show unless you ask.

Before proceeding on the tour: sit down with the guide to discuss your background, preferences, needs, or anything at all that you think might be helpful to know. This guide can cater the tour to your interests and needs. Make a list of your priorities.

Ask the guide to show you:

  • All the rooms and wings throughout the facility—private, semi-private, and bedrooms for 3-4 residents (short-term and long-term beds)

  • Dining area

  • Joint spaces where patients and residents can be together

  • Kitchen – Ask to see the kitchen and pay attention to its cleanliness

  • All individual departments, including the maintenance department. Ask to meet every department head that’s present

  • The grounds

  • Activity area

  • Rehab area

General Questions to Ask about the Facility

  • What is the size (number of beds) of the facility? Size is only important to determine how many beds they need to fill. Large facilities must take patients and residents that need behavioral care. Ask about how many homeless and uninsured patients they take. Also, if they accept uninsured patients, you know that they are accepting patients with problems that other facilities may not take. Ask about how they separate the patients and residents with differing needs. You don’t want your sweet mother to be roommates with a potentially dangerous person or one that will make their stay more stressful.

  • What are the care services offered? Is the facility capable of taking complex medical cases? Facilities that are equipped for high acute (complex) care are often a step above others.

  • Are multiple levels of care offered? Long-term, Short-term Rehab, Hospice, Palliative Care. Do they have full time nurse practitioners.

  • Is the home JCAHO accredited (JCAHO is a nonprofit health care accreditation organization)? If not, it’s not a red flag, JCAHO accreditation is not required by law, but it is a sign of the facilities focus on improvement.

  • What's the staff to resident ratio? Ask how they adjust staffing for patient needs. Facilities report general staffing, but you want to know what the ratio is for rehab patients (short-term) and long-term patients. Ask if they use nursing registries to staff. Registries can be good, but this is a sign of high turnover and short staffing.

  • Ask about turnover and how they handle care when short staffed

  • How do they handle patients with behaviors like elopement, yelling, violent patients, and those that need mental health. Even if your loved one does not currently need mental health care or have behaviors, they may need that type of care while they are there.

  • What is the restraint policy?

  • Who are the visiting physicians? Do they use Nurse Practitioners or Physicians Assistants to help handle the caseload? How often do the physicians visit the patients? Can your Primary Physician visit and care for you or your loved one? If not that’s okay, your physician may not be willing to visit. If the facility physician is new, ask why they are a good fit.

  • Is the nursing home for-profit or not-for-profit? Be cautious of for-profit facilities. Many for profit facilities provide better care than non-profit facilities; however, many for-profit facilities put profit over patient care, so you need to understand how autonomous the facility is when it comes to making decisions and investing for better patient care and specific needs.

  • Are they part of an Accountable Care Organization? This shows a direct relationship between their profit and patient care. It’s often a good thing.

  • Is rehab available for long-term patients? Do they employ RNAs (Restorative Nursing Assistant) who provide additional services? What?

  • Which insurance providers does the facility contract with?

  • Does the home have a religious or fraternal affiliation? If not, how do they handle religious needs and wants?

  • Ask if you will be able to meet with the Business Office Manager to discuss how the care will be paid for. You must understand this.

Be Observant During the Tour

Be aware of how the people interact with each other and the residents and observe if and how the guide engages with the residents.

Things to look for:

  • Does staff speak respectfully to the residents? Sometimes the staff must speak up if the resident is hard of hearing but pay attention to their tone and demeanor.

  • Does the facility smell of strong disinfectant or urine? Odors are tale-tell signs that bedding and clothing are not changed promptly. At times there will be temporary smells, depending on patient needs. If you smell feces, ask why. Sometimes these smells are unavoidable due to care needs.

  • Do residents have bedsores that are not treated? When you look at the state inspection survey pay attention to whether the facility has received bed sore related deficiencies.

  • Are residents groomed? As you pass through the hallway, take note of resident hygiene. Check for details like polished nails, and if the residents have jewelry on. Pay attention to clothing that has food stains to get a sense how quickly the facility helps them change their clothes.

  • Does the facility have a warm, homey feel? Remember, this is a care facility, so be reasonable. This is never going to be an ideal situation. You are looking for the best facility for your loved one.

  • Are plants, paintings, and lamps placed throughout the community, giving an added feeling of home?

  • Do lounges offer a feel of comfort?

  • Does the facility offer activities and entertainment? Are there residents that look bored and neglected?

  • Are handrails installed in the hallways for mobility ease?

  • Are rooms clearly marked and significant and personalized information displayed? This is more relevant on the long-term side of the facility.

  • Are the activities calendar posted and easy to read?

  • Ask if you can have a free visitor meal? Taste what the residents eat.

Resident Rooms

·       Ask to see a sample of each room type; private, semi-private, and the group rooms. Look at the space in each room and how much room there is between the beds and other furniture.

·       Is it easy to move around in?

·       Are the rooms wheelchair accessible?

·       Have the residents made their space personal by adding more color using a flowery blanket or bedspread?

·       Ask about their policy on personal belongings? Some homes encourage residents to bring personal belongings while others do not.

·       Do the rooms encourage privacy? Does a curtain or divider hang between the beds of a semi-private room?

·       Are the bathrooms shared? If they are, how many residents share the bathroom?

·       Notice what residents are doing in their rooms, walking around, sitting up, reclining on their beds, or lying in them? Is the resident dressed? All residents have rights. The facility is required by law to allow residents their freedom. Ask about resident rights.

·       It's better to see residents moving about rather than lying around, unless they are taking naps.

·       Ask as many questions as you feel are important to your decision.

Activities, Entertainment, and Recreation

·       Does the recreation and activities room double for dining too? If so, it suggests limited activities; however, the facility may have an excellent activities program even if this is the case. Just ask how they provide activities and ensure the residents have options to be engaged and stimulated.

·       What are the activities? Are birthdays celebrated? Are photos from past activities on display? Is the room decorated for seasonal fun?

Speak with the Activities Director. Ask how they encourage residents to participate? Do they actively pursue residents to join in? A sign of a healthy Activities Director is one that successfully rounds residents up to join in, and one that encourages them by changing up activities to meet the desires of the residents. How often do patients and residents have the opportunity to go on outings away from the facility?

Since residents have differing interests, the activity calendar needs to serve a variety of things to do and offer a varied entertainment schedule. They include:

  • Mental stimulation

  • Entertainment

  • Religious worship

  • Social events

  • Fitness

  • Interaction

  • Creative opportunities

  • Smaller group activities

  • Off-site activities

The more fun and activities scheduled, the more you'll enjoy living there.

Therapy Program

If you or your loved one is there for short-term care and rehab, this is the most relevant part of the tour; however, many short-term patients transition to long-term so if that is a risk, make sure you understand the long-term side as well.

Ask about the staff of the department; qualifications, licenses, physical therapy assistants, or therapist aides, and if they're contracted or staffed by the facility. Employed therapist offer greater continuity of care for residents. Outside contractors are not consistently serving the residents. Continuity between staff lessens because contracted therapy changes out therapists more often depending on their business needs.

Watch how the department operates. Are therapists working with residents one-on-one in addition to group therapy.

·       Is the therapy room crowded?

·       Do therapists have adequate space to perform treatment?

·       How do therapists complete bedside therapy if necessary?

·       Is the therapy equipment in good shape?

·       Is the department equipped for physical, occupational, and speech therapy?

·       Will the therapist go on site to the resident's home and do evaluations before discharge? If the facility does not ensure the transition home is safe and equipped properly, the patient will likely end up back in the hospital and the facility.

·       Ask how they manage the transition to home. Pay attention to how they follow up with the patient. Facilities that do this well prevent rehospitalization significantly. Ask them if they will come to the home to assess needs if they are declining.

Dining

·       Is the dining area equipped to accommodate all residents? How do they encourage short-term patients to eat in the dining room. This is good for patients to get out of their rooms.

·       If the dining area is small, ask where the residents eat?

·       Are some residents assisted when they eat? Do the residents who need assistance have good experiences. Do RNAs assist or CNAs?

·       What happens if a resident misses a meal? How do they track weight loss, weight gain, bowel movements and dietary needs (critical for prevention of decline and bowel impaction)? The facility must provide food that is edible and safe depending on physician orders.

·       What is the facility's policy on residents eating in their rooms? Residents do have a right to eat in their room, if they choose to.

·       Meet the dietician, if possible, to ask how they customize special diets, preferences, and how they ensure a healthy diet? This is a big deal.

·       Look at the food menu and glance the food that's served up. Is it appetizing and nutritious?

·       Ask if you can have a visitor meal to taste the food. Don’t be too picky but make sure it’s edible and healthy. Ask questions.

Kitchen & Food Service Tour Checklist

Cleanliness & Sanitation

  • Is the kitchen visibly clean and free from clutter?

  • Are food prep surfaces sanitized and separate from dirty dishes?

  • Are floors clean, dry, and free of spills or debris?

  • Are handwashing sinks accessible, with soap and paper towels?

  • Are food service staff wearing gloves and hair coverings?

  • Are garbage bins covered and emptied regularly?

  • Are refrigerator/freezer doors clean and properly sealed?

Food Safety Practices

  • Are cold and hot food items stored at safe temperatures?

  • Is raw meat stored separately from ready-to-eat foods?

  • Are temperature logs maintained for refrigerators and freezers?

  • Is food labeled with preparation and expiration dates?

  • Are dishwashing and sanitizing machines in working condition?

  • Are cleaning supplies stored away from food prep areas?

Nutrition & Meal Delivery

  • Is there a registered dietitian on staff or available?

  • Can they accommodate special diets (diabetic, low-sodium, gluten-free, vegetarian, etc.)?

  • Is food plated in a sanitary area — not near trash or dirty dishes?

  • Are meals attractive and portion sizes appropriate?

  • Is there a process for reporting lost appetite, weight loss, or difficulty swallowing?

Staff and Inspection Records

  • Are staff certified in food safety or ServSafe?

  • Are most kitchen workers full-time or contract?

  • When was the facility last inspected by local health authorities?

  • Can you see the most recent food service inspection report?

Tip: If allowed, ask to see the kitchen during mealtime prep, not just off hours. This gives you a clearer view of how operations run under pressure.

Outside Grounds

·       The outdoor area of the nursing home facility.

·       You can easily evaluate this part of the facility by simply viewing it, but there are a few specific things to look for.

·       Is it accessible by wheelchair and walkers?

·       Do residents have easy access to an outside area where they can enjoy being outside?

·       Are paths and doorways wide enough to access with a wheelchair or walker?

·       Are there plenty of sitting areas and places for residents to enjoy the fresh air and have conversation with one another?

·       Are shaded areas available?

·       Can residents go outdoors to enjoy fresh air when they want to or are they limited?

·       How do they handle smokers? How do they ensure smoking areas are separated from non-smoking areas? How do they ensure smokers are smoking safely?

Completing the Tour

Once your tour is over, you'll get a chance to ask more questions. Use this time to get a better feel for the nursing home's philosophy, because the attitude of the staff is ultimately what nursing home quality boils down to.

·       Ask what makes this nursing home different from others? Does the answer sound generic and full of sales rhetoric?

·       Do they speak genuinely about the staff and the home?

·       Do they mention making it home-like, accommodating, and speaks to resident needs rather than company needs?

·       Does the facility staff appear tight-knit and friendly with each other?

·       If the person you are meeting with has pride and personal investment in the home—which is obviously a wonderful thing for nursing home employees to have, this will come across in this conversation.

·       Family involvement is important for many residents, ask how involved your family can get? Can they get involved in the care plan? How do care conferences work and who is involved?

·       Ask if the nursing home makes any efforts to give their residents control over their own care? This depends on the patient but get a sense how open the facility is to patient and resident desires.

·       How active can residents be in how the facility operates; meal planning, gardening, and running of the facility?

o   Are residents involved in planning activities? Is there a Resident Council? Talk to the President of the Resident Council (this will be a resident) and ask them about the facility.

·       Do they participate in pet therapy? Are residents allowed to bring their pet? They probably cannot have their pet permanently, but ask if you can bring their pet in when you visit.

·       Do they have intergenerational daycare programs allowing residents to visit offsight with their spouse, children, and friends?

·       Speak with staff too, especially the direct care workers like nurses and nurses' aides. They provide the one-on-one care for residents. Are they treated well by the facility administration? What are the staff benefits and educational opportunities?

·       Hopefully at the end of tour, you walk away with full knowledge of whether the facility is a good fit or not. If you do not, then schedule an appointment to return later to speak with the Administrator, Director of Nursing or the Social Worker.

·       Ask to meet the administrator to get a feel for them. Are they regularly involved in the organization and management of the facility? This is the person who is responsible for ensuring the facility is running well. The medical care is delegated to the Medical Director and the Director of Nursing; however, the administrator should be closely involved. Ask what they do every day. If they are spending a lot of their time outside the facility, this could be a red flag.

·       Don’t forget to speak with the Business Office so you know exactly how the care will be paid for and what needs to be paid privately and what the hidden costs are. Also ask what happens if their Medicare runs out and how to qualify for Medicaid. Hopefully you have gone through the Genera Legacy Design course, Financial and Legacy Planning for Families to understand how to qualify for Medicaid, even if you do not think you will qualify.

·       Some return to the nursing home without an appointment to ensure you see the authentic and realities of the day-to-day. You will have to decide for yourself what will be more helpful and appropriate for your decision-making process.

 

Additional Notes: