How to choose a nursing home: a step-by-step checklist

Start by clarifying the type of care your family member needs. In the US, “skilled nursing” typically means round-the-clock care from licensed nurses and therapy as medically necessary. “Long-term care” focuses on ongoing help with daily activities over time.

If the person is coming from a hospital stay, ask the discharge team what setting they recommend (often short-term skilled nursing/rehab vs longer-term placement). Care setting affects coverage and cost.

If you’re worried about eligibility, remember: help with Medicare or Medicaid is separate from immigration status. Families may be able to get assistance regardless of immigration documentation, depending on the program and the state.

In the US, Medicare’s Care Compare (on Medicare.gov) shows Nursing Home “Five-Star” ratings. These ratings have three separate parts: (1) health inspections, (2) staffing, and (3) quality measures.

A higher star rating is helpful, but it should not be the only factor. Two facilities can have similar overall stars while the underlying staffing and quality measures differ.

If you want a consistent way to compare, focus on staffing first. Staffing—especially how many residents each nurse or aide covers—often affects daily care more than marketing language. When reviewing details, look for patterns rather than one-time changes.

Before touring, prepare a short question list. Ask about availability, the specific level of care they provide, and how they handle common needs (like mobility support, wound care coordination, or therapy schedules) in general terms.

Try to avoid sharing medical records on the phone. For matching and comparison, it’s fine to ask general questions first. If the facility later requests documents, you can review what they ask and share only what is necessary.

If you want language support, ask directly: “Do you provide staff who speak [language]?” Many facilities can arrange interpretation for family communication.

A tour is for your eyes as much as for your questions. Watch how residents move, how staff speak to people, and whether staff respond calmly. Look for clean common areas, well-kept rooms, and clear safety practices.

Pay attention to staffing signals: Are staff busy but organized? Do call lights appear to be answered promptly? Are residents sitting alone for long periods or engaged with activities? These observations can help you judge whether the written staffing plan matches real life.

If you can, bring a checklist and take notes. Try to visit at a time that reflects the person’s likely schedule (for example, late morning or mid-afternoon).

Use the tour to ask staffing and care-process questions in plain language. A helpful approach is to ask, “How do you make sure residents get help when needed?” and then follow up.

Key topics to cover:
- Staffing: How many nurses and nurse aides are scheduled across shifts (day/evening/night), and how does the facility handle short staffing?
- Nurse oversight: How is nursing care supervised and communicated to clinicians?
- Therapy and rehab: If rehab is needed, how is therapy scheduled and tracked?
- Communication: How do staff update families, and what is the process for addressing concerns?

Staffing ratios can change during the week and after admissions. Ask how often staffing levels are adjusted and what the facility does when staffing is lower than planned. This is often the most meaningful decision factor.

Costs vary widely by state, the facility, and the room type. As a rough planning guide, skilled-nursing/nursing-home care often runs about $7,000–$13,000+ per month, and some situations cost more.

Medicare may cover short-term skilled care for up to 100 days after a qualifying hospital stay, but coverage depends on the person meeting Medicare’s criteria. After day 20, many people have cost-sharing. Medicaid can cover long-term nursing care for those who qualify based on income and assets, and the rules vary by state.

Important: qualifying for care is separate from immigration status. If you’re unsure, check official sources (Medicare.gov for Medicare and your state Medicaid office for Medicaid). If the facility offers financial estimates, treat them as estimates and ask what they’re based on.

If you’d like, you can also use Get matched to facilities or our Skilled Nursing Facility Matching service to help compare options. Northhaven Care is a free matching + information service, not a care provider or government program. Some participating facilities pay a flat fee to be matched; this does not change what you pay and it does not affect our guidance about Medicare or Medicaid.

Even the best plans can go wrong. Choose a facility where you feel comfortable raising concerns and where communication feels reliable. Ask what happens if a resident’s condition changes, and how quickly families are notified.

If something feels off after admission, keep records of your concerns (dates, times, what was observed, who you spoke with). For formal help, you can contact your state’s long-term-care ombudsman program. These programs are designed to help families understand rights and pursue resolution.

Avoid anyone who guarantees an outcome or promises a guaranteed “spot.” In nursing care, openings depend on assessments and availability, and no one can responsibly promise an admission or improvement.