Questions to Ask Before You Commit to a Nursing Home: A Tour Guide
The most revealing questions to ask on a nursing home tour about staffing, care plans, costs, dementia care, discharge and what to watch for while you walk the halls.
The most revealing questions to ask on a nursing home tour are about staffing, how care is planned and delivered, what the total monthly cost includes, and under what circumstances a resident can be asked to leave. Equally important is what you observe: how staff treat residents, how quickly call lights are answered, and how the building smells and feels at different times of day. Bring a notebook, ask for written answers and compare facilities using the same questions.
Before you go
Look up each facility on Care Compare at Medicare.gov and note any inspection findings or penalties you want to ask about. Call ahead to schedule a tour with the admissions director, and ask to speak with the director of nursing and the social services director. If possible, plan a second, unannounced visit during a mealtime, evening or weekend. Print the Tour and Move-In Checklist.
Questions about staffing
Staffing is the strongest practical predictor of day-to-day care, so spend most of your time here.
- How many residents does each nurse aide care for on the day, evening and night shifts?
- How many registered nurses are in the building on each shift, including weekends?
- What percentage of your nursing staff are agency or temporary workers?
- How long has the administrator been here? The director of nursing? How many have there been in the past few years?
- What is your staff turnover rate, and how do you keep experienced aides?
- Do aides work with the same residents consistently?
- What training do staff receive in dementia care and in preventing falls and pressure injuries?
Be wary of vague answers such as "we always have enough staff." A good facility can tell you its actual ratios and discuss how it adjusts when someone calls out.
Questions about care and daily life
- How are care plans created, and how do families take part? When is the first care plan meeting?
- Who is the physician or nurse practitioner, how often do they visit and can my relative keep their own doctor?
- How do you prevent and treat pressure injuries, falls and infections?
- What is your policy on physical restraints and medications used to manage behavior?
- How do you help residents who need assistance eating? How do you handle dietary needs and preferences?
- Is there a regular schedule for bathing, and can preferences be honored?
- What activities are offered, including for those who stay in bed or in their rooms?
- What are visiting hours, and can family help with meals or care?
- How do you handle religious services and cultural needs?
- Can residents bring furniture, photos and small items?
Questions about health care access
Ask about on-site therapy hours, how quickly a resident is sent to a hospital in an emergency, the pharmacy that supplies medications, access to specialists such as podiatry, dental, vision and hearing, and the facility's relationship with local hospitals and hospice. If the resident has dementia, ask about wandering prevention and how staff respond to agitation without relying first on sedating drugs. See memory care and dementia in nursing homes.
Questions about money
| Question | Why it matters |
|---|---|
| What is the all-in monthly rate for my relative's care level? | Base rates can hide extras. |
| What is not included? | Therapy, supplies, salon and transport are often extra. |
| What deposits or admission fees are required, and are they refundable? | Avoid surprises. |
| How often and by how much have rates increased in recent years? | Helps you budget. |
| Do you accept Medicare, Medicare Advantage, Medicaid and long-term care insurance? | Determines future payer options. |
| If private funds run out, can the resident stay on Medicaid in the same bed? | Avoids a forced move. |
| What is your bed-hold policy during a hospital stay? | Affects cost and return. |
Request the answers in writing along with the full admission agreement. Our Monthly Cost Estimator can help you project the total.
Questions about discharge and complaints
- Under what conditions can a resident be discharged or transferred, and what notice is given?
- What is the process for raising a concern, and who handles it?
- Is there an active resident council and a family council?
- Can I see the most recent state inspection report? (Facilities must make it available.)
- What happened with any serious findings in the past two years, and what changed?
The answers tell you whether the facility welcomes scrutiny. Facilities that are confident in their care usually answer openly.
What to observe while you walk
Questions only go so far. Use your senses.
- Call lights: Are lights lit above doors? How long until staff respond?
- Residents: Are they clean, dressed, appropriately positioned, and engaged? Or are many parked in hallways in front of a television?
- Staff behavior: Do they smile, knock before entering rooms, call residents by name, and speak respectfully?
- Smell and cleanliness: Occasional odors happen, but persistent urine or strong cover-up scents are a concern.
- Noise and calm: Is it chaotic, or reasonably peaceful with ordinary activity?
- Dining room: Does food look appetizing and is help offered to those who need it? Are residents given enough time?
- Safety: Handrails, clear hallways, working alarms, and secure exits where needed.
- Interactions with families: Do visitors seem comfortable and welcomed?
Take photos only with permission, since other residents' privacy is protected.
Talk to people who are not on the tour
Ask residents who seem willing, visiting relatives, and aides on break. Contact the local long-term care ombudsman, who often knows about complaint patterns. Ask your relative's doctor or hospital social worker which facilities they trust, and ask what they hear about each from patients.
After the tour
Within 24 hours, write down what you noticed while it is fresh. Score each facility on staffing, atmosphere, clinical fit, cost and location. Review the contract at home. If anything made you uneasy, trust that and ask follow-up questions or move on.
Frequently asked questions
Can I visit without an appointment?
Facilities that participate in Medicare or Medicaid must allow reasonable access to residents' families, though they can require sign-in. Unannounced visits are a good way to see typical conditions.
How long should a tour take?
Plan at least an hour, and longer if you want to eat a meal or sit in on an activity.
Should I bring my relative on the tour?
If they are able and willing, yes, because comfort and fit matter. If not, share photos and your notes.
What if the facility won't answer a question?
Note it. Reluctance to share staffing, inspection results or costs is itself information.
Sources
- Medicare.gov Care Compare — inspection results, staffing and quality data
- Centers for Medicare & Medicaid Services — resident rights and nursing home requirements
- National Long-Term Care Ombudsman Resource Center — advocacy resources and state contacts
