Questions to Ask on a Nursing Home Visit

Finding the right nursing home fit for a loved one can be a challenging proposition. The options are many, but the industry may seem completely opaque if you haven't had interaction with any long-term care facilities in the past. This is why visiting a home -- and asking a lot of questions -- before you place a loved one there is a critical part of the process of securing good care for them.

There's so much to think about when considering whether to place a loved one in a particular home, that it can be challenging to know where to start. The following list of questions may help guide you through some of the most important questions and help you avoid becoming overwhelmed when visiting a home.

Answers to these questions, which can be broken into five main categories, can help you understand whether a specific nursing home is right for your loved one:

-- 1. Questions for a top administrator or director of nursing. These top-line questions determine whether your loved one's basic needs can be met in the facility and how the facility is run.

-- 2. Questions for the nursing staff. Speaking with nurses who work in a home can provide important insight into what their workload is like and whether they enjoy their work. Lisa Zamosky, senior director of consumer affairs for eHealth, one of the largest online health insurance exchanges in the U.S., urges you to "learn as much as possible about the staff that will be caring for your loved one." Consistency in staff and a low turnover rate are important clues that a home may be well run.

-- 3. Questions for residents. Other residents may be the best source of information about what it's really like to live in a particular nursing home. If they seem alert, clean, happy and relaxed, that can be a good sign that this is a top-notch home.

-- 4. Questions for other families. Talking to other families can also provide insight on what life is like inside the home and how your loved one will be cared for. If they've had a good experience, your family might too.

-- 5. Questions you can answer yourself. After all these conversations, take a moment to review what you've learned and look around. Ask yourself some important questions about the facility and the people you meet there and asses your gut response.

[RATINGS: Best Nursing Homes.]

In addition to speaking with as many people who are affiliated with the home as you can, you should also tour the buildings and grounds. Zamosky says that "when visiting a nursing home, first take in and assess the appearance of the living spaces and the residents you come in contact with."

Figuring out how to pay for care is also a key component of finding the right place for a loved one. Zamosky recommends asking about what insurance plans the home honors and whether your loved one's insurance plan covered nursing home care. "Many people are surprised to learn that Medicare generally does not pay for most nursing home care except for up to 100 days in a skilled nursing facility after a qualifying hospital stay of at least three days. For long-term care in a nursing facility, people either pay out-of-pocket or tap into long-term care insurance if they have that type of coverage."

Medicaid is the state-federal program that covers medical expenses for people with low incomes and will provide some financial assistance to people living in nursing homes. The catch is, the individual must first spend down all their assets before Medicaid kicks in. Not all homes accept Medicaid, so be sure to ask about financial arrangements before moving a loved one into a home.

The following list of questions can help guide you through the series of interviews you should seek to conduct when assessing whether a certain nursing home is right for your loved one.

[See: Beyond Bingo: Innovative Activities at Today's Nursing Homes.]

1. Questions for a Top Administrator or Director of Nursing

Problems or Special Needs

-- How would your home deal with my father's [dementia, weight loss, disability following stroke or _______________ ]?

-- Do you provide innovative services or therapy options for people coping with chronic disease, such as dementia or Parkinson's disease?

Toileting

-- How do you handle incontinence?

-- How often do staff members help incontinent residents use the restroom?

-- Are many in diapers?

-- Do you ever use catheters?

Nutrition

-- How flexible is your menu -- can residents make choices and are all Monday meals the same, for instance?

-- How do you identify residents who are losing weight, and how is that situation typically addressed?

-- What do you do to make sure residents are eating, especially those who have lost interest in food?

-- Can residents eat meals whenever they want, or are meals only at scheduled times?

-- Are healthy snacks available?

-- Does your home honor medical, religious or cultural dietary restrictions? Could you show me a sample menu of a [gluten-free, dairy-free, Kosher, low salt or ___________ ] diet?

-- How do you ensure that your meals meet high nutritional standards?

Falls

-- What do you do to prevent falls?

-- How often do residents fall?

-- What do you do when there's a fall?

Health Inspections

-- Please show me your last three survey inspection reports.

-- How has your home fixed any problems that were identified?

-- How quickly were the problems addressed?

Medical Care

-- How often is a doctor on site?

-- Are dental services available?

-- Does your home arrange for regular hearing or vision screening?

-- How do you keep track of residents' medical records?

-- If you have computerized health records, have you ever had any problems with the system such as data breaches?

-- Do residents receive preventive care such as annual flu and pneumonia shots?

-- Is vaccination mandatory for residents and staff?

-- If Mom has a medical need, who contacts the doctor?

-- If Mom needs to see her doctor, who arranges for transportation?

-- What hospital arrangements do you have for emergencies?

-- Do you offer telehealth options?

Staffing

-- What is the annual rate of your nurse and nurse aide turnover?

-- What do you do to try to improve turnover?

-- How often do you use agency temp nurses?

-- What proportion of families would you say hire private nurses to supplement your staff nurses?

-- How often do nurses update doctors on residents' health status?

-- What kinds of background checks do you perform prior to hiring?

-- Do you have volunteer programs?

-- Do you have a relationship with local schools or houses of worship?

Worrisome or Missing Data

-- I would like to discuss a few problems I've found out about such as: a high percentage of residents with moderate to severe pain, NA entries, etc.

Safety

-- Do you have an emergency evacuation plan?

-- Do you hold regular fire drills?

-- Who helps residents with bathing?

-- Do you conduct nightly bed checks?

-- How often does the staff check on residents during the day?

-- Do you use any high-tech resident monitoring services?

Payment

-- Does your facility accept my loved one's health insurance or long-term care insurance plan?

-- Do you accept Medicaid payments?

-- How do you bill residents and what are your fees?

Overall Direction

-- What improvements have you put in place in the past year?

-- What other improvements are planned?

-- Do you often have to put residents on a waiting list? If so, what's the typical waiting period for a bed to open?

-- Where would we direct our questions and concerns if we were to enroll our dad here?

[See: 14 Ways to Protect Seniors From Falls.]

2. Questions for the Nursing Staff

Workload

-- How many residents do you care for?

-- Is that too many or about right?

-- About how much time do you try to spend with each resident?

Employee Feedback

-- Do you like working with older people?

-- Is this a good place to work?

-- What do you like best/least about working here?

-- Do you receive training and continuing education?

-- What do you get if you take part?

3. Questions for Residents

Quality of Life

-- Do you have friends here?

-- Are you as busy as you want to be?

-- Does the home arrange outside activities for you?

-- Can friends and family visit whenever they want?

-- Do you get to suggest or plan activities?

-- Do your visitors ever bring pets with them?

Nursing Staff

-- Do you like the nurses and aides?

-- Do you have the same ones most of the time or do they change a lot?

-- Do they help you to the bathroom, and if you need help, do you get it in time?

Nourishment

-- Do you ever need help eating?

-- If so, do you always get help without waiting too long?

-- Are you often thirsty?

-- Do you have a special diet? (If yes: Do you like the diet choices?)

-- Do you like the food here?

4. Questions for Other Families

Nursing Staff

-- What are your loved one's medical concerns?

-- Does she get enough of the right kind of care?

-- Does your loved one like the nurses and feel safe with them?

Falls

-- Has she ever had a fall here? If so, what happened, and were you satisfied with how it was handled?

-- How confident are you that it won't happen again?

Toileting

-- Does he receive the help he needs to go to the restroom?

-- Have you ever come to visit and found him sitting in his own waste?

Nutrition

-- Does your loved one need assistance eating?

-- Does he get help? Does he have a good appetite? Does he like the food?

-- If not, does the nursing home do anything to help stimulate his interest in food?

Medications

-- How well do you think the staff here manages your loved one's prescriptions?

-- Have there been medication-related problems?

-- If he is drowsy, confused, or inattentive, do you believe he may be receiving too many drugs or the wrong ones?

Quality of Life

-- Does your loved one participate in activities?

-- Are there options beyond bingo and movies?

-- Are there activities suited for different levels of cognitive ability?

-- Do residents take excursions outside the home?

-- Is your loved one dressed in her own clothes when you visit, or is she wearing a hospital gown?

-- Was your mom able to bring personal belongings, such as pictures or furniture, with her when she entered the home?

-- Is there enough storage space, such as closets?

Ratings

-- Can you help me understand some aspects of the ratings or the health inspections that aren't clear? How significant is _________ violation? How would you evaluate the way the home handled the problem?

Personal Evaluations

-- Do you think this home will be able to meet my dad's needs?

-- Is there anything you know about this nursing home that you think would help me make my decision?

[See: 11 Things Seniors Should Look for in a Health Provider.]

5. Questions You Can Answer on Your Own

Visitors

-- Is the parking lot full?

-- Are grandchildren or other family or friends around?

Resident Engagement

-- Are there lots of activities available, and are they well attended by residents?

-- Is the facility creative, regularly offering outings to museums or baseball games, art classes or gardening on the grounds?

-- Do volunteer musicians and other entertainers visit regularly?

-- Do children or young adults from classrooms or youth groups come to do crafts, perform or participate in other activities with residents?

-- Is there a beauty salon or barbershop?

Quality of Life

-- Are residents dressed in hospital gowns or their own clothes?

-- Do they seem socially engaged and happy?

Staff

-- Do staff members appear to genuinely be concerned about the well-being of residents?

-- Do the nurses and aides inspire confidence that they can appropriately care for your loved one?