Finding the Right Nursing Home


Carol and Bob invited his mother, Ginny, to spend the holidays with them, as she does every year. This year, her live-in caregiver expressed concern that it was not a good idea because Ginny’s dementia has gotten worse and she may not recognize her own grandchildren. Ginny cannot do much independently anymore and needs help with most activities of daily living, including preparing meals, bathing, and using the bathroom. The conversation with the caregiver was the confirmation Bob needed that the time had come to look for a nursing home for his mother.

Bob didn’t have the most favorable impression of nursing homes, until he visited his Uncle who thrived in one that was immaculately clean, had a homelike atmosphere, and boasted rooms that were cheerfully decorated with resident’s personal possessions. He thought this particular nursing home would be perfect for his mother, if it wasn’t so far away. With so many nursing homes in the DC Metro area to choose from, how will he find the right one? And more important, how can his mother afford it?

When seniors and their families plan ahead, they can make multiple visits to facilities to find the one that best meets their needs. But if, like Bob, you have no choice and need a nursing home for a loved one right away, there are tools you can use to begin your search. The federal government’s online tool, Nursing Home Compare, can be a good starting point for consumers. The site offers star ratings for all nursing homes that participate in Medicare (for short-term rehabilitation) or Medicaid (for long-term care). The ratings are based on the facility’s performance on health inspections, staffing hours for nurses and nursing assistants, and quality measures, such as the prevalence of pressure ulcers and falls among residents.

Another site, Nursing Home Inspect, is a consumer-oriented tool that can help you compare nursing homes’ inspection results and run-ins with regulators. ProPublica, an investigative news organization, launched this online tool to enable consumers to compare nursing homes in their state based on problems found by regulators and the financial penalties imposed. It is also wise to call your state department on aging and your local long-term-care ombudsman’s office to ask about any state sanctions and consumer complaints against facilities you’re considering. You can find links to your state programs at the Eldercare Locator.

When it comes to quality of care, in my experience with clients and in writing the Nursing Home Survival Guide, I have found that while online rating sites are worthwhile, they do not tell the whole story. There are also some important things you should do (and look out for) before selecting a nursing home for a loved one:

  • Take a tour during regular business hours.
  • Have a meal.
  • Schedule another visit late in the evening or on a Sunday afternoon, to get a sense of round-the-clock life in the facility.
  • Pay attention to smells, sounds, and temperature.
  • Observe whether residents are engaging in activities or sitting around listlessly. Also, ask the administrator about activities for residents.
  • Check the bulletin boards for information on resident and family council meetings. Leaders of these groups, which advocate for residents in the home, can provide insight on any concerns about the facility.
  • Observe whether residents are sitting around waiting to be fed at mealtimes or waiting to go to bed after dinner. If so, the facility probably doesn’t have enough staff.
  • Ask about the level of staff turnover, which tends to be fairly high in nursing homes. If they’ve had four administrators in one year, it may be a red flag.
  • Ask the facility if it practices “consistent assignment,” meaning that the same aide is assigned to care for the resident each day. In facilities that don’t use consistent assignment, residents can have as many as 20 or 25 different people caring for them in a month.
  • Ask about the ratio of staff to residents. A good minimum ratio would be about one to five during the day, one to ten in the evening, and one to fifteen at night.

Before you or your mother sign the admissions agreement, understand what you’re signing, and do not sign any paperwork unless everything has been fully reviewed by an experienced  Elder Law attorney. Keep in mind that almost all admissions contracts are written to be lean in favor of the facility, and often at the disastrous financial expense of the nursing home resident’s family member who signs the contract as the “responsible party.”  However, these provisions can always be eliminated from the nursing home contract by an experienced Elder Law attorney.

Bob, in our example, is concerned about affordability of nursing home care. This is a legitimate concern for many people in his situation, as nursing homes in Northern Virginia cost $10,000-12,000 a month. To protect your family’s hard earned money and assets from these catastrophic costs, the best time for your father to create his long-term care strategy is NOW.  It is never too late to nursing home receiving long-term care, it would not be too late to do Long-term Care Planning, also called Lifecare Planning and Medicaid Asset Protection Planning. Please call us at 703-691-1888 in Fairfax, 540-479-1435 in Fredericksburg, or 202-587-2797 in Washington, DC to make an appointment for a consultation.

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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.