Before You Choose a Nursing Home . . .

Q. I recently read a sad article in the Washington Post about an Alexandria woman named Anne Bailey Farr (not sure if she is a relative of yours?), who is facing charges in connection with the death of her 98-year-old mother, who was found by police on her bedroom floor. When questioned, Farr stated that her mother had fallen out of bed 24-48 hours before the fire department was called, and that she did not provide her mother with any food or medication during the hours she spent on the floor. A pill bottle containing blood pressure medication for Friday and Saturday was found near her mother’s body. In my opinion, Ms. Farr’s mother would have been much safer in a nursing home, where her medication would have been monitored, and she would have never been in the situation described.

The story caught my eye because, as a caregiver for my 90-year-old father, I often wonder if he is better off in a nursing home. He had a stroke last year, and ever since, he has had trouble with balance and mobility, and his memory is starting to diminish. Although I would never leave him alone for too long and would never neglect his needs, I worry about what happens when I have to leave the house for a little while to walk my dog, get the mail, or pick up a few items at the grocery store.

I believe a nursing home is the best place for my father, and like most people in my situation, I want to choose one with highly trained staff that will meet his needs and ensure his safety. In your experience, what are some things I should look out for when selecting a nursing home for my father?

A. I read the article about Ms. Farr and her mother (who are not relatives of mine) and I too was saddened about the situation and feel it could have been prevented had she been in a nursing home with skilled caregivers and medication monitoring.

In your situation, given your father’s health concerns, you are making a wise choice in looking into long-term care options, such as skilled nursing home care, for him. In my experience with clients and in writing the Nursing Home Survival Guide, I have found that these are some important things you should do (and look out for) when selecting a nursing home for your father:

  1. Make scheduled and unscheduled visits:  When you’ve located a few facilities that you’d like to consider more thoroughly, plan on visiting each one, at different times and on different days of the week. Make sure you visit during mealtime, to ensure that during the busiest of times, residents seem to be getting enough food or drink.
  2. Pay attention to smells, sounds, and temperature: As you are walking around, take note of what you hear and don’t hear. Is it silent? Is there activity? How clean does it look? Are the residents dressed appropriately for the season? When it comes to smell, if it smells like urine, that’s obviously a bad sign. But if all you smell is pine cleaner, I’d be a little suspicious about that, too, wondering what odors it is covering. You want the place to smell like a clean home, with no strong scent that’s good or bad.
  3. Ask about activities for residents:  A quality nursing home is going to have a daily calendar of activities in which your father can participate. If your father is room-bound, activities should be brought to his room.
  4. Find out the ratio of nurses to residents and the turnover rate: The marketing person or admissions director will probably give you the tour, but try to meet the director of nursing, the administrator, and the executive director too. Ask how long they’ve worked there. Ask how long their predecessors were there. If it’s less than six months, and you see a pattern, that should be a concern; high administrator turnover can be an indicator of a lower quality of care. In addition, ask the nursing assistants and other staff if they work a lot of overtime and double shifts. If so, they may be overstressed and it also could be a sign of short staffing that can affect patient care. You can also check out a nursing home’s staff ratio rating on the Nursing Home Compare tool at
  5. Know your rights: When you’ve decided on a facility, you should know your rights and those of your family member. Before you or your father sign the admissions agreement, understand what you’re signing, and do not sign any paperwork unless everything has been fully explained.
  6. Review policies: The admissions contract should, at a minimum, contain the daily room rate, reasons for discharge and transfer from the nursing home, and the policy regarding payment of the daily room rate if your father goes to the hospital or the family brings the resident home for a short period of time.

Nursing homes in Northern Virginia cost $9-12,000 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.  Generally, the earlier someone plans for long-term care needs, the better.  But it is never too late to begin preparing.  Even if your were father were already in a 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 or 540-479-1435 in Fredericksburg to make an appointment for an introductory 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.