How to Choose a Nursing Home

Nobody wants to move into a nursing home.

That’s why most older adults who need some care support begin with in-home services. Typically, this involves someone(s) coming to the home to help with Activities of Daily Living (ADLs) — things like assistance with personal hygiene, meal prep, or light housekeeping.

But over time, in-home care is sometimes not enough. Remaining at home can become unsafe for older adults, some of whom may develop dementia with a risk of wandering or have repeated falls. Also, as the amount of in-home care increases, so too does the cost; it can become unmanageable for some families. At that point, a nursing home often becomes the only option.

Overall, and with the exception of those who are there for short-term rehab to recover from an illness or injury, there are really only two reasons why somebody lives in a nursing home:

Medical. Nursing homes can provide a high level of skilled nursing care. They are staffed with nurses 24/7 and provide access to everything a resident may need: doctors, nurses, medication, medical equipment, etc. Some have specialized memory care units as well. For people who require skilled nursing care around the clock, this is the only setting where this is available.

Financial. After demonstrating a medical need, and for those who establish that they truly cannot afford to pay for the care on their own, Medicaid (it’s called MassHealth in Massachusetts) pays for everything in a nursing home.

What To Avoid When Choosing

There are big differences in the quality of nursing homes and the care they provide. So, it’s important to know which criteria really matter when considering options.

Here, in increasing order of importance, are things to avoid when weighing these differences…

#5. Using Location as the Primary Criteria

It makes sense to want to stay close to family, community, and other support systems that an older adult may have developed over the years. But don’t make location the main consideration. You don’t choose a dentist — or even a hairdresser — based solely on where they are located; the same applies to choosing a nursing home.

#4. Soliciting Recommendations

Getting suggestions through crowdsourcing (e.g., Facebook, community bulletin boards, neighbors) is hard to resist. The problem is that the suggestions you will receive can be out of date, misinformed, and/or not filtered based on your specific needs and circumstances. Casual suggestions that are shared, while well-meaning, may not be particularly useful and often create additional stress.

Even professionals — doctors, attorneys, financial planners — tend to see just a piece of the overall puzzle. It can be helpful to listen to others as you do your research, but don’t put all of your stock in word of mouth recommendations.

#3. Judging on Appearance

It’s easy to be swayed by a newly renovated facility that has things like a nice chandelier in the foyer and beautifully maintained grounds. But that’s not what really matters — the gardener is not the one taking care of your mom! The truth is, some of the best care we have seen is delivered in older, even antiquated, buildings. And the care is what is most important.

However, we do recommend making judgments based on some parts of a facility’s appearance, including cleanliness, potential safety hazards and, especially, the people who work at the facility. Do they look you in the eye and say hello as you take a tour? Do they seem glad to be working there? As we have been known to say, happy staff equals happy residents!

#2. Waiting Too Long

Many of the best nursing homes have wait lists that can be six months long or more. If you delay researching options until you have an urgent need, you will have fewer choices.

So start early and apply to several. There is no cost to completing an application and the sooner you get on a wait list, the more options you are likely to have.

#1. Staying In a Bad Situation

A nursing home is not a one-way street! It is actually rather easy to transfer from one to another if the care is not up to par or the fit is not right. After all, this is a person’s home and it’s important that they feel comfortable.

You’ll need to weigh the benefits of disrupting your loved one’s routine and making a switch, but this is definitely an option and we have seen it lead to much happier living situations.

Do Your Best

Moving to a nursing home can be a difficult and emotional transition for older adults and those who love them.

You will make that transition go as smoothly as possible if you start early, consult with experts, and keep these important ideas in mind.


P.S. A terrific resource for getting unbiased, quantifiable information is the Nursing Home Compare web site. It’s run by Medicare.gov and has all kinds of detail related to staffing ratios, care performance, inspection results and more. There’s a lot of information here and our Nursing Home Advisory Service can help you hone in on which facilities in your area you should focus on. Feel free to get in touch with us if you want help sorting through it!

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