Like Their Patients, Every Nursing Home is Unique

Making the decision to enter a nursing home is never easy, and once it’s made comes yet another difficult task – the task of choosing the right facility. While the process of selecting a nursing home may seem overwhelming at first, it helps to remember that all facilities share the common goal of providing quality, round-the-clock patient care in an environment as homelike as possible. Beyond that, every nursing home has certain areas of expertise, offers certain special services and may be better suited to a certain type of clientele. In other words, specific factors, such as payment method, location, and availability of special care units, will make one nursing home better suited to a patient than another.

For instance, if the patient is eligible for Medicare or Medicaid, the selected nursing home must participate in the program through which the patient is receiving assistance. Most Tennessee nursing homes accept Medicare patients, but, due to strict medical qualifications, just 15 percent of nursing home patients receive Medicare coverage to pay for their nursing homestays. Almost 90 percent of Tennessee nursing facilities participate in the Medicaid program, and the majority of Tennessee nursing home patients, approximately 68 percent, receive care that is paid for by Medicaid.

Location may be the most often-cited factor that influences facility selection. Nursing home patients and their families often prefer a facility that is close to the family’s home or hometown. Location can be a key factor in a facility’s atmosphere, and the lifestyle of the community in which the facility is located – urban, suburban or rural – usually is reflected in the lifestyle of the facility.

Another consideration is the special services or features of a facility. The development of special care units to better treat certain disabilities is a growing trend in nursing homes. Facilities may have specialized units to care for patients with certain injuries or illnesses, such as Alzheimer’s disease, or offer special therapy programs or treatment not available at other facilities.

Where to Begin

The first step in the selection process is to seek referrals. Valuable information can be gained by talking with long-term care professionals, hospital discharge planners and social workers, your family physician, and friends or acquaintances who may have first-hand knowledge about choosing a facility. The information you obtain from these sources will help clarify the issues and focus your perspective.

And remember, nursing home placement can be tremendously stressful for both the person needing care and the family. Seek agreement by involving the patient and family members in decision-making issues of facility selection. This not only will help relieve immediate concerns but also ease the transition into the chosen nursing home.

Facility Visits: A Checklist

The best way to determine the appropriate match of nursing home services and patient needs is through facility visits. Facilities may be screened by calling and asking questions, thus saving time and effort. However, it’s a good idea to plan personal visits to at least three facilities, involving as many family members as possible.

All facilities offer tours to prospective patients and their families. Some help visitors experience what the facility has to offer by allowing them to sit in on activity programs or other events. Ideally, you should visit each nursing home more than once to observe activities throughout the day. At least one visit should include a mealtime, which allows you to sample the food and see the patients in a social setting.

Although the initial visit should be arranged with the administrator so that you may ask specific questions of staff, management and volunteers, follow up visits can be unscheduled. During each visit, evaluate the interaction between patients and their caregivers. If possible, meet with the facility’s family council, or if no council exists ask to speak with family members of other patients.

The selection of a nursing facility is a crucial decision. All questions should be answered and any doubts resolved before making a final choice. Following is a checklist of suggested inquiries that can help you conduct effective and successful facility visits.


  • Does the facility hold a current license from the state?
  • Does the administrator hold a current license from the state?
  • If the answer to either of these is “no,” find another nursing home. The nursing home you are dealing with could be some other type of facility falsely claiming to be a nursing home.
  • Ask the administrator to describe the facility’s most recent survey (state/federal inspection).


  • Is the patient happy with the location?
  • Will family and friends be able to make frequent visits?
  • Does the patient’s personal physician make visits to the facility?

Facility Appearance and Design

  • Is the entire facility clean enough to satisfy your personal standards?
  • Is it free of unpleasant odors?
  • Are hallways and rooms free from hazardous objects?
  • Does the facility meet the safety standards required for nursing homes?
  • Do you feel welcome when you enter the nursing home?
  • Does everything appear organized and well-maintained?
  • Are the grounds neat and well-kept?
  • Is the view pleasant?
  • Is there outdoor furniture for the patients to use?
  • Are there areas where patients can enjoy being outside? Are they encouraged to do so?
  • Have certain rooms been designated for physical examinations or therapy?
  • Is there a room for private visits with family and friends?

Staff Attitudes

  • Is the facility’s general atmosphere warm and pleasant?
  • Do staff members show interest in and affection for individual patients?
  • Are staff members courteous and respectful?
  • Do staff members know patients by name and take time to deal with them personally?
  • Do staff members and the administrator take time to answer all questions, hear complaints and discuss problems?
  • Do staff members respond quickly to patient calls for assistance?
  • Are visiting hours convenient for patients and visitors?
  • Does the staff encourage family visits?

Bedrooms and Bathrooms

  • Is there a window in every bedroom?
  • Does each bed have a privacy curtain?
  • Does each bed have a nurse call button or bell?
  • Is fresh drinking water at each bed?
  • Does every patient have a comfortable chair in the room?
  • Are there reading lights?
  • Do patients have their own clothes closet and drawers for personal items?
  • Are personal items throughout the room and on the walls?
  • Is the furniture spaced so that a wheelchair can maneuver easily?
  • Is each bed easily accessible?
  • Are the bathrooms convenient to the bedrooms?
  • Are bathrooms easy for wheelchair patients to use?
  • Does each bathroom have a nurse call button or bell?
  • Are hand grips on or near the toilets?
  • In shower areas, do showers and tubs have non-slip surfaces and hand grips?


  • Is the dining room attractive and inviting?
  • Are the tables and chairs comfortable and safe?
  • Is it easy to move around, even for those in wheelchairs?
  • Is the food fresh, tasty and attractively served?
  • Does it appear that the food served is among that preferred by patients?
  • Is there a pleasant variety from meal to meal?
  • Are patients given enough time to eat?
  • Are they served at normal meal times?
  • Do patients receive help eating if they need it?
  • Is food delivered to the rooms of patients unable to eat in the dining room?


  • Is there adequate room for patients’ activities?
  • Are activities planned?
  • Are all patients able to get involved in some activity?
  • Is equipment available to use for activities (i.e., games, craft supplies, books)?
  • Are patients using the equipment?
  • Are patients’ preferences of activities observed?
  • Are outside trips planned for patients able to enjoy them?
  • Do volunteers work with patients?

Patient Care Services

  • Does the nursing home have an arrangement with a nearby hospital for transfer if necessary?
  • Is emergency transportation readily available?
  • Is a physical therapy program available under the direction of a qualified therapist?
  • Is therapy available to meet patients’ particular needs?
  • Is occupational and/or speech therapy available?
  • Is a social service worker available to assist patients and family?
  • Is a registered nurse available for nursing staff?
  • Are barbers and beauticians available for patients?
  • Do staff members encourage patients to maintain a neat appearance? Do they help if needed?

Patient Rights

  • Does the facility have a written description of patient rights and responsibilities?
  • Is the description readily available for patients and families to review?
  • Are staff members trained to protect dignity and privacy and respect the patients’ rights?
  • Does the facility have a patient council?
  • Have arrangements been made for patients to worship as they please?
  • Have arrangements been made to accommodate patients who celebrate religious holidays?


  • Are most services covered in the basic daily rate?
  • If not, is a list available of specific services not covered in the basic rate?
  • Does the facility accept Medicaid payments?
  • Does the facility accept Medicare payments?
  • What is the facility’s policy on returning advance payments?

Your Part: Family Involvement

  • Does the facility have a family council?
  • Are you prepared to ease the patient’s transition to the nursing home by being with him or her for several hours on admission day?
  • Are you ready to visit the patient frequently and ask his friends to also visit regularly?
  • Are you willing to provide the patient with the same amount of love in the nursing home as you would if he were at home?