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Guide to Choosing a Nursing Home (Part III)

Health Care Financing Administration (HCFA) has published a booklet entitled "How to Choose a Nursing Home."

Table of Contents

Beginning the Search

Seek Referrals

Before visiting nursing homes, get information about available options from a variety of different people: professionals in the long-term care field (such as the local ombudsman, see below) to friends or acquaintances who have been in a situation similar to yours. They can help focus your search for a nursing home. In that way, you can save some time and avoid needless frustration.

Once again, it is important to remember that choosing a nursing home will require you to use critical judgment at a variety of levels. That final judgment should also include your intuitive "gut feeling." In addition, you should seek information from a broad base of sources and not rely on any one source in making your decision.

Long-Term Care Ombudsman Program

The Ombudsman program is a significant part of the nursing home system. Federal law requires each State Agency on Aging to have an Office of the Long-Term Care Ombudsman, and more than 500 local ombudsman programs now exist nationwide. These offices provide help and information to older Americans, their families and friends regarding long-term care facilities.

Ombudsmen visit nursing homes on a regular basis, and they often have knowledge of what goes on in facilities in their communities. In addition, they receive and investigate complaints made by or on behalf of nursing home residents and work to resolve the problems. If they are unable to resolve problems or if they find serious violations of standards in the facility, ombudsmen refer complaints to State Health Departments for action.

Ombudsmen can also provide information on licensed long-term care facilities in the state or local area, usually including some descriptive information. They cannot advise you on any one particular nursing home, but they will supply current information regarding nursing homes near you. Ask the local ombudsman about: 

    • Information from the latest survey report on the facility
    • Any complaints against the nursing homes you plan to visit
    • The number and nature of complaints for the past year against the facility
    • The results and conclusions of the investigation into these complaints and
    • What to look for as tell-tale signs of good care in facilities.

If there are local advocacy groups or support groups for the aged and their families, they will also be good sources for recommendations.

Other Community Resources

While the ombudsman program is a good place to begin your search for a nursing home, there are many other valuable community resources that you should consult before deciding which nursing homes to visit. Among these resources: 

    • Hospital discharge planners or social workers
    • Your family physician
    • Religious organizations
    • Volunteer organizations such as Pets on Wheels
    • State nursing home associations and
    • Close friends or relatives.

In meeting with these resources, ask about the facility's reputation in the community. Does the facility have a list of references especially family members of current residents?

Other Key Factors to Consider

As you set about deciding on a nursing home, it is also important for you to distinguish between your wants and your needs. To that end, you should ask yourself: 

    • What kind of care do you need and 
    • What is the lifestyle you would like to lead in the facility?

Different kinds of nursing homes provide different types of care yet all must provide certain basic services. The key is to match the home to the resident to ensure the nursing home provides the person the kind of care and services needed.

Some people may want a safe and comfortable place to live among pleasant companions. You may want a home that places special emphasis on ethnic factors, such as special food or foreign languages, while others may prefer similarity in religious background.

On the other hand, other residents may require help with grooming and occasional medical treatment. Still others may require constant medical attention, therapy, and other skilled nursing care.

Once you identify what you want and need in a home, simply telephoning some of the nursing homes on your list may eliminate the need to visit them. Some of the key questions that you may ask over the phone to facilities are: 

    • Is the nursing home certified for participation in the Medicare or Medicaid programs? 
    • What are the facility's admissions requirements for residents? 
    • What is the "typical profile" of a resident in the facility? For example, if you require temporary rehabilitation services and the nursing home specializes in Alzheimer's disease care, it's probably not a good match. 
    • Does the nursing home require that a resident sign over personal property or real estate in exchange for care? 
    • Does the facility have vacancies, or is there a waiting list?


As you develop your list of potential nursing homes to visit, you should also consider the location of the facility. For example, how close is it to family members and friends? How easy is it for people to visit? How near is it to other community contacts and resources that you hope to continue to see and use?

Enrollment in a Managed Care Plan

If you or your family member is enrolled in a health maintenance organization (HMO) or competitive medical plan (CMP), ask a representative of the plan about coordination of health care services between the HMO/CMP and the nursing home. Ask which nursing homes the HMO or health plan works with in the area. If you are interested in a nursing home outside of the area served by the HMO, discuss this with the plan representatives.

Public Information

Your State Health Department produces a yearly report on the performance of each nursing home that is certified for Medicare or Medicaid. You should review the latest report. It is required to be posted at the nursing home and is also available through your state health department or from the local ombudsman program. You should talk to the nursing home administrator and long-term care ombudsman about the results of the survey report. What did the nursing home do to correct problems, if any, that were identified in the report? The Health Care Financing Administration, which administers the Medicare and Medicaid programs, also produces an annual report on nursing home information that allows consumers to compare performance of different nursing homes on a variety of measures.


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