Guide

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

Updated October 15, 2026 · Reviewed against official sources

Choosing a nursing home for your mom or dad is one of the biggest decisions a family makes. It's often done in a rush, right when a parent is leaving the hospital. This guide gives you a clear order to follow so you can decide with good information and peace of mind, and get off to a good start with the team that will care for your loved one.

Step 1: Figure out what your loved one needs

Not every older adult needs a nursing home. Before you start looking, answer these questions:

• Do they need nursing care every day (wounds, tubes, oxygen, injections)?
• Can they bathe, get dressed, eat and use the bathroom on their own or with a little help?
• Do they have memory problems, get disoriented or wander out of the house?
• Are they coming from the hospital to do rehab for a few weeks, or do they need a place to live?

Use the Katz and Lawton scales as a guide (they are not a diagnosis) and talk with the doctor or the hospital social worker. If they need less help, look at the types of care: assisted living, an adult day center or a caregiver at home may be all they need.

If your loved one is able to share their opinion, include them from the start. This guide can help you talk with your mom or dad about moving.

Step 2: Figure out how you'll pay

Before you get attached to a place, make sure you can afford it today and two or three years from now.

• Medicare pays only for a short rehab stay, if the requirements are met. Read what Medicare covers.
• Medicaid pays for a long-term stay if your loved one qualifies. Ask if the nursing home accepts Medicaid and if it has Medicaid beds available. Read Does Medicaid pay for nursing homes?
• If you'll pay with savings, ask: "If the money runs out and my mom switches to Medicaid, can she stay in the same room?" Many families go through this change, called a spend down (using up savings until you qualify), so it's good to know the answer from the start.
• If your loved one is a veteran, look into Aid and Attendance benefits.

Check prices in your state in how much a nursing home costs.

Step 3: Make a short list

Look for places close to whoever will visit the most. Frequent family visits bring your loved one joy and help the staff get to know them better.

• Use the guided search or see places near you.
• Browse the directory by state.
• Save 3 to 5 options and compare them side by side.

If someone offers you free help with your search, it's useful to know how senior living advisors work.

Step 4: Check the official data

You can do this step from home, and it helps you arrive at the visit with good questions.

License and certification

Every nursing home must have a state license. If it accepts Medicare or Medicaid, it's also certified by CMS (the federal agency for Medicare and Medicaid), and its inspections are public. In our directory, each listing shows the official CMS data and its date.

Medicare star ratings

Medicare rates nursing homes from 1 to 5 stars in three areas: health inspections, staffing and quality measures. Look at each one separately, not just the overall rating. The inspection and staffing ratings usually tell you more about day-to-day life. Learn how to make sense of them in how to read Medicare star ratings.

Other Medicare indicators

Care Compare (Medicare's comparison tool) shows other information that's worth knowing and talking about with the facility:

• Abuse icon: it means recent inspections found abuse-related citations that meet certain CMS criteria. We show it on each listing.
• Special Focus Facility (SFF): a CMS program for facilities with several years of inspection results below what's expected. CMS inspects them more often and follows up to help them improve. While they're in the program, Care Compare doesn't show star ratings for them.
• Fines, and recent changes of owner or administrator.

None of these data points tells the whole story. A report is a snapshot of one moment, and many facilities make important changes after an inspection. The most useful thing is to ask respectfully: "I saw this on Medicare's website. What happened, and what have you changed since then?" The answer says a lot about how the team works.

Inspection reports

Read the most recent deficiencies on Care Compare. Pay attention to the severity (whether residents were actually harmed) and whether the same issue shows up several times. Some states have search tools with more detail, like Cal Health Find in California or the Department of Health profiles in New York.

Step 5: Visit in person

Bring our visit checklist. Go at mealtime and, if you can, come back another day at a different time, like on a weekend or late in the afternoon. That way you see what the normal routine is like.

What to look for:

• Does the place feel clean and well kept? Are residents clean and dressed?
• Do staff greet residents by name and speak to them with respect?
• Are call lights answered quickly?
• Are residents doing activities, talking or walking around?
• Does the food look appetizing? Do staff help residents who need help eating?

What to ask:

1. How many nurses and aides are on each shift, during the day, at night and on weekends?
2. How long have most of the staff worked here?
3. Are there staff who speak Spanish on every shift? What about the social worker or the charge nurse?
4. Do you provide an interpreter for care plan meetings and for talking with the doctor?
5. Can you make food my loved one will recognize? Do you have Mass or other religious services?
6. What are the visiting hours? Can I bring food from home?
7. How will you let me know if there's a fall or a change in health?
8. Which hospital do you use for emergencies?
9. Do you have a resident council and a family council?

For language, read nursing homes with Spanish-speaking staff and how to find a care home that respects Latino culture. In our directory, the "Spanish spoken" label appears only when the facility itself says so.

Step 6: Take your time reading the contract

Ask for a copy of the admission agreement so you can read it at home. If something isn't clear, ask them to explain it; that's what the admissions staff is there for. You can also get free advice from the long-term care ombudsman in your area.

Parts of the contract to read carefully and confirm in writing:

• Who signs, and in what role. Under federal law, a nursing home certified by Medicare or Medicaid can't require a son, daughter or other relative to personally guarantee payment as a condition of admission. You can sign as a representative to manage your loved one's money and pay with their income, without becoming responsible for paying with your own money. Make sure the contract says that.
• Arbitration agreement. This is an agreement to settle disagreements with an arbitrator instead of going to court. Federal law says signing it is optional and can't be a condition for admission or for continuing to receive care, and that you have 30 calendar days to cancel it after you sign. Take time to decide if it's right for you.
• Resident rights. The contract should not ask your loved one to give up their rights, their right to apply for Medicare or Medicaid, or the facility's responsibility for lost personal belongings.
• Payments and deposits. If your loved one has Medicaid, the facility can't ask for gifts, donations or extra payments as a condition of admission. Ask which extra services cost money and how leftover balances are returned: federal law requires returning them within 30 days after discharge.
• Price list. Ask for a list of the services that are included and the ones that cost extra (hair salon, phone, cable TV, transportation).

Learn about your loved one's rights in resident rights and complaints.

Step 7: Prepare for move-in and work as a team

• Bring the medication list, legal documents (like the power of attorney and advance directives) and things that bring comfort: photos, a blanket, music. See what to bring to the care home.
• Take part in the care plan meeting in the first few weeks. Tell the team what your loved one is like: their likes, their fears, how they like to be spoken to.
• Visit often and at different times. Write down your questions so you can bring them up.
• If something worries you, talk about it first with the charge nurse or the administrator; most issues get solved that way. If you need support, the ombudsman helps residents, families and staff find solutions.

It's normal to feel guilt or sadness at this stage. It may help to read about the guilt of moving mom into a nursing home.

If your loved one is leaving the hospital in a day or two, start with our hospital discharge page. The hospital must give you a list of available facilities and respect your loved one's preference as much as possible.

💬Frequently asked questions

How many nursing homes should I visit?

Ideally, visit at least two or three. Comparing helps you notice differences in how people are treated, the atmosphere and the food that don't show up in the data.

Can I visit without an appointment?

For a tour with the admissions staff, it's best to call ahead. Also ask if you can stop by another day without an appointment, at a different time: that second visit shows you the everyday routine.

What matters more: the star ratings or the visit?

They complement each other. The star ratings sum up inspections and staffing data; the visit shows you how people are treated, the language and the atmosphere. Use the star ratings to prepare questions and the visit to decide.

Do I have to sign the arbitration agreement?

No. Under federal law, in a certified nursing home it's optional and doesn't affect admission. If you sign it, you have 30 calendar days to cancel it.

Licensing rules and some protections vary by state. This guide is for information only and is not legal or medical advice. If you want to go over what other families have learned, read common mistakes when choosing a nursing home.

Sources

• Medicare.gov, Care Compare: https://www.medicare.gov/care-compare/ (accessed October 15, 2026)
• CMS, Five-Star Quality Rating System: https://www.cms.gov/medicare/health-safety-standards/certification-compliance/five-star-quality-rating-system (accessed October 15, 2026)
• Medicare.gov, Special Focus Facilities: https://www.medicare.gov/care-compare/resources/nursing-home/special-focus-facilities (accessed October 15, 2026)
• eCFR, 42 CFR Part 483 (requirements for nursing homes, including 483.10, 483.15 and 483.70): https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-483 (accessed October 15, 2026)
• California CDPH, Cal Health Find: https://www.cdph.ca.gov/Programs/CHCQ/LCP/CalHealthFind/Pages/Home.aspx (accessed October 15, 2026)
• New York State Department of Health, Nursing Home Profiles: https://profiles.health.ny.gov/nursing_home/ (accessed October 15, 2026)
• National Consumer Voice, long-term care ombudsman directory: https://ltcombudsman.org/ (accessed October 15, 2026)

This is general information, not medical, legal or financial advice. Rules vary by state and by year: confirm with the official agency that applies to you.

👉Keep reading

How to read star ratings

What Care Compare star ratings measure for a nursing home: inspections, staffing, and quality. What the abuse icon and the SFF program mean.

Rights and complaints

Federal nursing home resident rights, how to resolve concerns with the staff, what the ombudsman does and how to file a formal complaint.

Care in Spanish

How to find a nursing home, assisted living or caregiver that speaks Spanish, your right to a free interpreter, and what to ask when you visit.

How to choose senior living without rushing: 5 practical tips

Take time to compare, look at daily care, read inspections in context, plan how to pay and review the contract: five tips to help you choose well.