You trust your parent’s nursing home to take care of him or her. Unfortunately, some homes do not deserve this trust. Nine secrets you need to know about nursing homes—public and private…

1. You would lose your taste for this facility if you visited during mealtime. Mealtimes are when nursing home employees are under the greatest stress. Some residents have meals served in their rooms, but most eat in a dining room. Try to look in on a meal—if employees are interacting with residents in a friendly and respectful manner, they probably treat residents well all the time.

2. Our nurses aren’t really our nurses. When nursing homes can’t find enough permanent nurses, they arrange for “agency nurses” to fill the manpower gaps. These agency nurses work for staffing agencies, not the nursing home, and they rarely stay long enough at a home to form a bond with the residents or get to know their needs.

Most facilities use agency nurses from time to time, but it’s a bad sign if more than 15% to 20% of a home’s manpower is provided by agency nurses. The facility should provide this statistic upon request.

3. Our physical therapy facilities and staff fall well short of our claims. Insist on touring the physical therapy department especially if your parent requires rehab. Does the equipment look modern and extensive? Ask your parent’s doctors if any special rehab equipment would be helpful, and confirm that this is present. Also ask whether the nursing home’s physical therapists are on staff or on contract—facilities with physical therapists on staff likely have made a greater commitment to rehab services.

4. We have less than four stars in the overall rating. The Medicare system’s Web site includes the Nursing Home Compare database, which rates every Medicare- or Medicaid-certified nursing home on a star system, with five stars indicating the best. Avoid facilities with an overall rating lower than four stars if you can afford to do so.

5. Our activities schedule is just for show—the main activity here is sitting and staring. Every nursing home has an “activities schedule” that inevitably lists an impressive array of things for residents to do each day. Look in on one or two of these activities next time you visit your parent. Is the activity really taking place? How many residents are participating? Does it look like they’re having fun? Be concerned if the main activity of most residents appears to be clustering around the nurses’ station in wheelchairs staring into space or at a TV. (Residents sitting around is perfectly fine—if they are chatting together, playing cards or interacting in some other way.)

6. Trust your nose. Some subpar nursing homes manage to make their facilities look presentable for visitors, but making them smell pleasant is a tougher challenge. Walk down a few corridors where doors to patient rooms are open and take a whiff. A bad facility might reek of urine, feces or large amounts of Lysol.

7. We can’t provide what our residents really want—privacy. The contentment of nursing home residents is closely correlated with their ability to obtain privacy, according to our research. Unfortunately, many homes offer mostly shared rooms. It doesn’t really cost that much more to build nursing homes with private rooms—it’s just a matter of adding a few extra walls—but many nursing homes were constructed before the importance of single rooms was widely recognized.

Helpful: If single rooms are not available in your parent’s price range, consider how much privacy the facility’s shared rooms offer. Some feature sturdy partitions…others just thin curtains or nothing at all between beds.

8. The more you visit, the better the care your parent will receive. Residents whose families visit often typically receive significantly more attentive care from nursing home employees than those who rarely receive guests. If you live far away, perhaps a friend or relative can visit regularly.

Helpful: Each time you visit, ask a question or two of a staff member. This sends the message that you are paying close attention to your parent’s care. But always be polite, and don’t let these questions become excessive or frivolous—you want the staff to consider you involved, not annoying.

9. We can kick your parent out at any time. Nursing homes cannot legally expel residents because they’ve run out of savings and must resort to Medicaid to pay. But nursing homes are allowed to send away residents who have come to require more care than the home can provide. Some disreputable facilities expel residents who run out of money by claiming that their care needs have increased.

If this happens to your parent, you could contact your state’s long-term-care ombudsman to file a complaint. (Find your state’s ombudsman through the Web site But even if the ombudsman agrees that the facility cannot kick out your parent, you probably don’t want your parent staying in a nursing home that would act this way, assuming that you can afford other options.


If your parent requires nursing home care following a hospital stay, there’s a good chance that the hospital discharge planner will give you just a few days to choose a nursing home. The longer your parent stays in the hospital, the less profit the hospital makes. (Medicare and health insurance plans typically pay a predetermined fixed amount for the treatment of a particular health problem, with no additional payments for longer-than-average stays.)

What most families don’t realize is that they can push back when discharge planners try to push their parents out the door. If you haven’t selected a nursing home yet, tell the discharge planner that you require more time and that you will file an appeal with Medicare if he/she doesn’t relax the deadline. The threat alone often is enough to make discharge planners back down—they don’t like the paperwork hassles associated with appeals. If not, file the appeal. Even if your appeal is rejected, the appeals process will buy you some additional time.

Helpful: The hospital’s patient advocate should be able to provide details about how to file this appeal. Or hire a long-term-care case manager who can help with filing the appeal and selecting a nursing home. You will have to pay this case manager a few hundred dollars, but it’s money well-spent. Your local Area Agency on Aging might be able to help you find a local case manager.