How to Choose a Nursing Home
Use ratings as a starting point, then inspect staffing, care plans, communication, and safety.
Do not choose by stars alone. Use Care Compare, then verify staffing, inspections, care planning, food, communication, fall response, and family access.
Nursing home decisions are often rushed after hospitalization. A rating can narrow the list, but it cannot replace walking the unit, asking hard questions, and understanding what kind of care is needed.
Quick answer
Do not choose by stars alone. Use Care Compare, then verify staffing, inspections, care planning, food, communication, fall response, and family access.
Choosing A Nursing Home Under Pressure
Choosing a nursing home is one of the most stressful care decisions a family can make, especially when it happens after a hospitalization.
The goal is not to find the perfect facility. The goal is to avoid making a rushed decision based only on availability, distance, or a brochure.
CMS created the Five-Star Quality Rating System to help families compare nursing homes, with ratings for health inspections, staffing, and quality measures, plus an overall rating.
Use Ratings, But Do Not Stop There
Medicare Care Compare can help you compare Medicare-certified nursing homes by location, care quality, and staffing.
But ratings are a starting point, not a full answer.
- A five-star facility may still be a poor fit for a specific person.
- A lower-rated facility may have improved recently.
- A rating may not reveal how staff communicate with families.
- A rating does not replace visiting, asking questions, and checking recent inspection issues.
Kefiw tip: use the rating to decide what to ask, not what to assume.
Ask About Staffing In Plain Language
Do not only ask, "What is your staffing ratio?"
Ask:
- Who helps residents at night?
- How often are residents checked?
- How long does it usually take to answer call lights?
- How do you handle falls?
- How are pressure injuries prevented?
- How often does the care plan get updated?
- Is there an RN on-site?
- Who calls the family after a change in condition?
Visit With Your Senses Open
Look for:
- Residents positioned comfortably.
- Staff speaking respectfully.
- Call lights being answered.
- Clean but lived-in spaces.
- Residents receiving help with meals.
- Clear hallways.
- Calm transitions.
- Staff who can answer basic questions.
- A visible rhythm of care.
Notice whether staff appear to know residents personally.
Ask About Care Planning
A nursing home should be able to explain:
- The care plan process.
- Who attends care plan meetings.
- How goals are set.
- How family concerns are documented.
- How falls are reviewed.
- How medication changes are communicated.
- How discharge planning works.
- How therapy progress is tracked if rehab is involved.
What Families Often Miss
The admission decision is not only about getting a bed.
Families should ask: "What would good care look like for my parent in this facility?"
For one person, it may mean rehab progress. For another, it may mean comfort and dignity. For another, it may mean dementia-sensitive supervision. For another, it may mean preventing pressure injuries or falls.
Family Script
"We are comparing facilities and want to understand how care works after admission. Can you explain how you handle falls, medication changes, family concerns, and care plan updates?"
Red Flags
- Poor communication before admission.
- No clear answer about call lights.
- Strong odors or visible neglect.
- Residents appear distressed or unattended.
- Staff seem unable to answer basic questions.
- Family complaints are minimized.
- Inspection issues are brushed off.
- Discharge planning is vague.
- The facility discourages family involvement.
Checklist
- Check Medicare Care Compare.
- Review health inspection rating.
- Review staffing rating.
- Review quality measures.
- Visit in person when possible.
- Ask about falls.
- Ask about pressure injury prevention.
- Ask about medication communication.
- Ask about care plan meetings.
- Ask about family updates.
- Ask about discharge planning.
- Document all answers.
Related Kefiw Tools
Professional Review
Recommended reviewer: clinician, nursing home quality expert, long-term care ombudsman-informed reviewer
Sources To Verify
Last reviewed: April 29, 2026.
Kefiw Care Planning Disclaimer
Kefiw provides educational care-planning tools and guides. This content does not replace medical, legal, financial, tax, or insurance advice. Care needs, coverage rules, costs, and eligibility vary by person, plan, provider, and location. For urgent medical concerns, call emergency services or contact a qualified medical professional.
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Related
Frequently asked questions
› Should I trust nursing home star ratings? Trust & accuracy
Use star ratings as a starting point, not the final decision. Read inspections, check staffing, tour the unit, and ask how the facility handles the specific care need.
› What is the difference between skilled nursing and long-term nursing home care? Definition
Skilled nursing is medical or rehab care under specific conditions. Long-term custodial nursing home care is ongoing help with daily needs and usually requires a different payment plan.
› Who helps with nursing home complaints? How-to
State Long-Term Care Ombudsman programs work to resolve problems related to health, safety, welfare, and rights in long-term care facilities.
› How should I use this guide with a Kefiw tool? How-to
Use the guide as the plan and the linked Kefiw tool as the check. Read the steps first, try the move manually, then use the tool to compare outputs, catch edge cases, and decide whether the result actually fits your task.
› What mistake do tool guides help avoid? Troubleshooting
Tool guides help avoid using a utility mechanically without understanding what you are trying to accomplish. Most word, writing, and text utilities are fast, but speed can hide context mistakes. Know whether you are solving a puzzle, cleaning copy, drafting a line, or checking a rule.