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Originating in the 17th century when European settlers brought the concept of almshouses (homes for orphans, older adults and people suffering from mental illness) to the U.S., nursing homes can be a helpful living environment for people who require higher levels of daily care. Read on to learn more about nursing homes, including what to look for in these living environments as you search for the best fit for your loved one.

A nursing home is a residential, long-term care option for older adults and people living with chronic conditions that require continuous care. They can also be referred to as long-term care homes, skilled nursing facilities, convalescent homes, adult foster care, rest homes and care homes.

At its core, a nursing home is a place people can go when they need short- or long-term care that requires a nurse’s supervision. Nursing home staff assist residents 24 hours a day, and the extent of care, services and amenities they provide can vary from one community to another. Find Care For The Ones You Love Conveniently search for local senior caregivers and senior living communities on Care.com. Join for free today

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Ideally, the search for a nursing home doesn’t begin bedside in a hospital. Instead, having conversations early about safe living environments with your loved ones gives you time to ask questions, find answers, understand their priorities and honor their wishes as they navigate the healthy aging process. You can visit some of the facilities or environments to see what they’re like, talk to people who live there and, if you schedule a tour, eat lunch at the facility.

Nearly 80% of people ages 50 and older want to stay in their homes as they age, according to a 2021 survey conducted by the AARP[1]Where We Live, Where We Age: Trends in Home and Community Preferences. AARP. Accessed 6/16/2022. . Meanwhile, the Kaiser Family Foundation (KFF) reports that nearly 1.3 million people in the U.S. resided in nursing homes in 2020[2]Total Number of Residents in Certified Nursing Facilities. KFF. Accessed 6/16/2022. .

When searching for a nursing home, it’s important to first consider the functional level of your loved one and their ability to care for themselves, as well as what their support system looks like, says Irene Nobles, legal nurse consultant and president of Allegiant Health Advisors.

“The best way [to search for a nursing home] is to find a local senior advocate or care manager who will have the most knowledge and experience as to what facilities provide the best care [in your area],” advises Nobles. Beyond that contact, here are some additional steps to inform your search.

Ask family, friends and people you know in the health care field—physicians, nurses, physical therapists, attorneys and the like—for their recommendations of nursing home facilities in your desired area. You’re likely to notice repeated recommendations among the group, says Craig Fukushima, a managing partner of health care consulting firm the Fox Group who has more than 30 years of experience in long-term care.

“You can also ask a local ombudsman,” he says. “They are local laypeople who help investigate complaints about nursing homes. If you have connections to home health care agencies, use those, too.” Your local Area Agency on Aging is another great resource—they’re located in every state and are divided by county.

All nursing homes that receive Medicaid and Medicare funding for their operations are required to abide by specific guidelines created to improve the quality of life for residents, such as maintaining minimum staffing ratios and having a nurse on duty during all hours of the day, per the Omnibus Budget Reconciliation Act (OBRA) of 1987. These nursing homes are searchable via Medicare’s Care Compare website. You can also explore Seniors Blue Book, which organizes all senior-related resources, support and communities available in a particular area.

Some nursing homes allow prospective residents and their loved ones to schedule tours of the facilities ahead of time. However, it’s best to arrive unannounced so the nursing home isn’t staged or prepared for your arrival, says Nobles.

Fukushima also suggests visiting at different times. “People tend to go after work, which is fine, but when I evaluate, I usually go around 9 a.m. or a little bit earlier because that’s when the morning shift starts,” he says. “They’re starting to get patients up and feed them breakfast. If it’s 10 a.m. and we’ve got people in their rooms and they aren’t up yet, that’s a problem. If they’re not up in their beds and groomed or haven’t received their morning care, that’s a problem.”

Be mindful that rules of engagement vary by community; due to the ongoing COVID-19 pandemic, some aren’t generally open to vendors or visitors.

What’s more, be sure to take the time to visit a community before your loved one really needs to relocate. You don’t want to be forced to make such a decision in a matter of hours, such as when they’re being discharged from an unexpected hospital stay. “You wouldn’t make a car-buying decision that quickly—don’t do it with a nursing home, either,” says Fukushima.

During nursing home tours, be sure to use all your senses:

By weighing all these specific considerations, you can gain a better understanding of which community might best suit your loved one’s needs.

After spending time with your loved one learning about their health and wellness needs, as well as their personal preferences and wishes, schedule an appointment with their health care provider. “Their order [typically] initiates the process of moving to a nursing home,” says Nobles. Once your loved one is deemed qualified for placement in this type of housing, there are several details to consider.

Focus on what’s most important to your loved one. Do they want to live within a certain distance of other family members or friends, including yourself? What’s more, consider how often you would visit them in this new home.

“When you start the [search] process, hospital staff typically won’t give you a recommendation,” says Fukushima. “Instead, they may give you a list of places they’ve worked with, which isn’t necessarily bad, but it’s not necessarily in your best interest, either.” Remember that your loved one is at the center of this conversation. Ask them where they would prefer to be and go from there.

Oftentimes when someone is hospitalized and unable to return to their previous independent living arrangements, they’re discharged to any local facility that has an available room, with little choice involved. However, if you’ve already visited places and have a preferred location list on hand, they may offer your loved one a choice that includes an option on that list.

Fukushima adds that it’s important to consider your role in the equation as well. “If you’re the [health care] power of attorney or caregiver and you live 30 miles away and want to visit them often, how do those details factor in? Weigh these factors, too,” he says. “People [often] use proximity to the hospital as a focus because they won’t transfer [your loved one] to a place that’s too far away, but take your location into consideration, [too].”

Many states are increasing minimum staffing arrangements for nursing homes on a permanent basis out of necessity born from the COVID-19 pandemic, so be sure to check your state’s requirements and confirm that any nursing home you’re considering meets these standards.

It’s also important to inquire about employee turnover and the type of staff leaving most frequently. “High turnover of both leadership and staff suggests job dissatisfaction and unresolved internal issues,” says Nobles. “High staff turnover also affects the continuity of care and can make it difficult for the staff to get to know residents.”

A 2017 review in Health Care Management Review finds facility size to be an important indicator of quality of care[3]Baldwin R, Chenoweth L, Dela Rama M, Wang AY. Does size matter in aged care facilities? A literature review of the relationship between the number of facility beds and quality. Health Care Management Review. 2017;42(4):315-327. . When exploring nursing home options, try to find one that’s large enough to suggest proper funding, but small enough to create a home-like environment suitable to your loved one’s needs.

Speaking of the environment, if your loved one lives in a nursing home with other residents who are happy and satisfied, you’re likely to see a similar disposition in them. A 2020 literature review in Public Health Reviews suggests increased autonomy, opportunities to participate in the community and greater solidarity among fellow residents are associated with a better quality of life and well-being in people living in nursing homes[4]Carrere J, Reyes A, Oliveras L, et al. The effects of cohousing model on people’s health and wellbeing: a scoping review. Public Health Review. 2020;41:22. .

Pay attention to how residents look during your tours of these facilities. Are they alert and engaged, or do they seem to be left alone for long periods of time?

Take a look at the facility’s activity calendar as well, and consider whether the events and opportunities they provide are age-appropriate and cater well to the interests and abilities of the residents. Can you see your loved one enjoying these activities? What’s more, Fukushima recommends watching resident and staff interactions during scheduled activities and seeing what you notice. If the staff is just turning on a record player and leaving the room, that’s sensory stimulation—not an activity.

What’s more, check out the facility’s food options. Even better, if you get a chance to eat, try the food yourself, suggests Fukushima.

Consider specific needs of your loved one and how they might be tended to in this environment as well. “For example, if they had a stroke and need therapy, talk to the therapist and interview them,” says Fukushima. “Ask them how they treat patients. Explain, ‘My loved one had a stroke. How would you approach them, and what would you do for them?’”

If you enter a facility and immediately notice a not-so-pleasant smell, take that detail at face value. Cleanliness is a key indicator of the quality of a nursing home. When a community smells clean and sanitized, it’s more likely that the employees provide a similar level of quality care to the residents. Plus, maintaining proper sanitation standards is key to keeping your loved one healthy and safe. When touring a nursing home, ask the staff about the facility’s sanitation policies and which products they use to address their primary concerns.

“When you visit, use all of your senses—not just your nose or eyes,” says Fukushima. “Be observant. Look at the patients. Are they up and well-dressed and groomed? Are their fingernails clean? Is their hair clean? Does their skin look healthy? Don’t be afraid to ask staff questions [about cleanliness], no matter who they are.”

Nursing home costs vary dramatically nationwide, falling as low as $180 a day in parts of Texas and Louisiana and reaching beyond $1,000 a day in parts of Alaska, according to the American Council on Aging[5]2021 Nursing Home Costs By State and Region. American Council on Aging. Accessed 6/16/2022. . Beyond location, cost is also affected significantly by whether your loved one wants a private or shared room and the extent of care they require.

Fukushima notes that daily costs for a private pay resident can vary widely depending on their geographic location. “I would say, on average, the private pay rate is around $300 per day for a private room,” he says.

Meanwhile, the first 20 days of a nursing home stay for a resident with Medicare are fully covered. Then, for days 21 to 100, assuming they continue to qualify for coverage, the resident must pay a coinsurance amount of $194.50 per day, explains Fukushima. Any day thereafter must be fully covered by the resident or another means of payment.

Medicaid, Department of Veterans Affairs (VA) benefits and long-term care insurance are additional options worth considering when looking to reduce the costs associated with living in a nursing home more permanently. Ready To Find A Personalized Medicare Plan? Keep your doctors, maximize your benefits, and save money when you use CoverRight’s online platform to compare Medicare Plans. Get Started

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The primary services offered by most nursing homes include:

Outside those core offerings, some nursing homes may provide specialty care programs as well. For example, if your loved one has dementia, you may be able to find a nursing home with a dementia care program that trains its staff in providing this specific type of care.

A resident’s “basic room and board needs are included in the daily fee charged by the nursing home provider,” says Fukushima. “Further clinical needs, such as therapy or medications prescribed by their health care provider, can also be handled by the nursing home for an additional cost.”

As you navigate your search for the best nursing home for your loved one, there are a few red flags to look for as well, according to Nobles.

These factors are crucial to assessing the quality of care provided by a nursing home and might not appear on other checklists.

Searching for the best nursing home for your loved one can be a tricky process, but with these tips in mind, your family is already several steps ahead. By remaining observant, asking lots of questions and keeping your loved one the focal point of the conversation, you can find a comfortable and caring space in which they can age safely. Find Trusted Senior Caregivers On Care.com Care.com helps you find local caregivers ready to help with meal prep, bathing, companionship, transportation and more. Get started on Care.com

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Jennifer Lagemann is a former family caregiver, as well as a professional caregiver and administrator at home care agencies. She works as a writer and researcher, helping care providers create patient- and family-friendly websites, articles and more.