Questions to Ask Before Choosing a Nursing Home


Making the choice to place an elderly loved one in a nursing home or assisted living facility is never easy. While it is often the best choice for both your loved one and your family, the task can be incredibly difficult, time-consuming, and emotionally-fraught. There are seemingly endless options to choose from—over 1,000 certified facilities in Texas alone—so how do you find the right nursing home for your parent, grandparent, or elderly family member?

One of the primary concerns of most people who are looking for a nursing home, apart from location, is cost. Certain studies have shown that the annual average cost of nursing home care in the United States exceeds $50,000. If Medicaid and/or Medicare will be paying for some or all of the costs, you will need to ensure that the nursing home you are considering is Medicaid/Medicare certified and approved. If the nursing home is not being covered by Medicaid or Medicare, you will want to find a facility that both meets your budget and offers an acceptable level of care for its residents. This is absolutely crucial, as nursing home abuse and neglect is an unfortunate reality in the U.S.

Additionally, you will want to review any facility’s nursing home inspection report, which you can request from the facility itself. You will also want to make sure that the nursing home in question has a current state license on display. It is also a good idea to always visit a potential nursing home facility prior to placing your loved one there.

Below, we’ve compiled some important questions that you should ask before choosing a nursing home. If you have additional questions or would like more information on finding an assisted living facility for your elderly family member or loved one, we encourage you to reach out to our firm at (713) 336-7200.

How many staff members are there compared to the number of residents?

It is common sense that the more staff members a facility has, the better able it will be to provide proper care for its residents. Unfortunately, many nursing homes have a low staff-to-resident ratio. A reputable nursing home will have enough registered nurses and nursing aides to meet the physical, mental, and emotional needs of all residents. According to The National Consumer Voice for Quality Long-Term Care, this means at least one caregiver for every five residents during the day, one caregiver for every 10 residents in the evening, and one caregiver for every 15 residents at night.

While there is no specific law addressing the ratio of nursing home staff to residents in Texas, federal law mandates that certified Medicaid/Medicare facilities have at least one registered nurse on duty for a period of 8 hours a day, 7 days a week. These same facilities are also required to have at least one licensed nurse on duty 24 hours a day.

While the nursing home should provide you with information regarding the number of RNs and nursing aides on staff, you can also find available staffing data for the state of Texas online. This information should include details regarding the average number of hours worked, mandatory breaks, hours spent with residents each day, and more. It is also a good idea to ask caregivers and other staff members if they often work overtime and, during your on-site tour, pay attention to the number of nurses and aides you see.

Is there a high rate of staff turnover?

As in most jobs, happy nursing home employees are stable nursing home employees. A high rate of staff turnover could indicate issues with management, training, and the facility itself. Additionally, there is a huge benefit to stable staff in that nursing aides and caregivers spend more time with each individual resident. Over time, they come to know the residents on a personal level and are therefore better able to provide a high level of compassionate and personalized care.

What activities are available for residents?

Often, when seniors enter assisted living, the transition can be somewhat difficult. It is equally important that the facility you choose not only provides for residents’ physical and medical needs, but for their social and emotional needs as well.

Ask about social activities that are available for residents, as well as how much time residents spend interacting with one another outside of their individual or shared rooms. A good nursing home will have various activities that residents can participate in. Take note if there is a calendar of activities or whether residents are congregated in communal areas. This is a good sign. For residents who are bedridden or who cannot leave their rooms, in-room activities should be provided.

What measures are taken to prevent bedsores, injuries, and accidents?

While some accidents are bound to occur, every nursing home should have policies in place that are designed to minimize risks for residents. Individuals that are not able to leave their beds, confined to wheelchairs, or relatively immobile should be moved at least every two hours to prevent bedsores, also known as pressure ulcers. Surfaces should be kept clean and sterile to prevent the spread of disease and/or infection. Ask about hygiene and disease-prevention expectations for staff members as well, such as how often nursing aides must wash their hands and whether or not they are required to get flu shots each year.

Additionally, the facility should have procedures for what to do if an accident does occur. What happens if a patient falls? Do patients have access to 24-hour care? What is the process for obtaining emergency medical treatment? These are all things that you should ask and the facility should be able to answer.

Is specialized care available for individuals with dementia, Alzheimer’s, and other specific needs?

Many elderly individuals who enter nursing homes do so because their family and loved ones are no longer able to meet the level of care they require. This is often due to the development or worsening of a certain health condition, such as Alzheimer’s or dementia. Additionally, with time, an elderly individual may develop one of these or another condition.

Particularly for individuals with memory-related issues, proper treatment and care are crucial. Inquire about special training for caregivers and nursing aides, including training on memory care, wandering prevention, and sensitivity.

Can residents continue seeing their own doctors, if desired?

Often, nursing homes have their own doctors that see to residents’ medical needs. However, if your loved one has been receiving treatment from a different doctor, he or she may have built a relationship with your loved one. Ask whether residents can continue seeing their own personal doctor and, if not, ask about how the facility helps residents transition to seeing a new medical provider. If your loved one requires medications or any special treatment, you will also want to inquire how the facility will accommodate those needs.

Other Questions to Ask Yourself during Your Tour

In addition to asking nursing home administrators and/or staff the above questions, there are a few important things you should note when taking your on-site tour.

While touring a potential nursing home, ask yourself the following questions:

  • What is the overall environment of the facility like? Do residents seem happy? Does the staff seem pleasant?
  • Are residents provided with individual rooms or do they share? Do all of the rooms have windows? Do the rooms have adequate beds and other necessary furniture?
  • Does the facility seem clean? Are there any unpleasant odors or visibly unclean areas? Are bed sheets clean and free of stains?
  • How does the staff address residents? Do they call residents by their names? If a resident cries out or yells, does the staff respond quickly and compassionately?
  • Does the food seem acceptable, both in terms of quantity and quality? Do the residents have consistent access to both food and water?
  • Does the nursing home offer an environment of acceptance and inclusivity? Are all residents treated the same, regardless of age, sex, race, orientation,and gender?
  • How much freedom do the residents appear to have? Are they able to move about as they wish? Are they confined only to certain areas?

You may wish to talk to staff members or residents in order to learn more about the facility, how it operates, and the overall happiness level of residents. The nursing home should allow you to do this—any attempt to stop you from talking to residents or staff is likely a red flag.

Ensuring Your Loved One’s Health & Happiness

The most important factor to consider when choosing a nursing home for your parent, grandparent, or elderly family member is their overall health and happiness. While choosing an assisted living facility can be incredibly difficult, it is often the right thing for both you and your loved one. Many nursing homes provide residents with the treatment and care they need to continue living happy and healthy lives. However, it is important that you take the time to thoroughly research all potential facilities in order to ensure that your loved one is properly cared for.

If you would like to learn more about choosing the right nursing home, or you need assistance with a nursing home abuse or neglect case, please contact Stepp & Sullivan, P.C. at (713) 336-7200 to speak to one of our Houston-based nursing home abuse attorneys.

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