Even when it is clearly the right decision, placing a family member in a nursing home can be a wrenching experience. Few of us will have any experience in the selection process and the stakes are enormously high. In addition the decision is likely to come at a time when we are emotionally—even physically—exhausted.

There are no foolproof methods for selecting among nursing homes. At Fleming & Curti, PLC, we have been through the process with clients, wards, and even our own family members enough times to have some suggestions that might help you make a better decision for your loved one.

We often advise clients that we think there are three components to nursing home quality. First is the physical plant. As you inspect the facility, look for wide hallways, good lighting (preferably lots of outside light streaming into the facility), clean walls and floors, with a floor plan and design that will help keep your family member oriented so that he or she can find the way from room to dining room and back. The smell of urine or cleaning chemicals may not indicate negligence on the part of staff, but remember that your family member will be spending all day in the facility every day, and that you and other visitors are less likely to come or to stay if you are uncomfortable.

The second component of a good facility is the staff. Watch for indicators of attitudes—do the staff members seem to enjoy their work environment? If they do, the care will simply be better. Interview the director of admissions, of course, but also talk to the social services director, the nursing director, and the occupational and physical therapists. These are the people who will be most responsible for your family member’s day.

The third component, and possibly the most important, is—–you. If the facility is near your work or home, you will be able to spend more time there and your family member’s care and comfort will both be better. If the staff knows you and other family members, and knows that you are involved and concerned, they are likely to respond by helping you and letting you help them to provide better care.

We often talk about the importance of roses and thorns. What we mean is that you should be prepared to provide genuine thanks to staff members (the roses, or cookies, or bagels—and don’t forget the night shift), but at the same time to be the thorn in their—or management’s—side to help keep the care at the level you need and expect.

There are also more scientific ways to check the quality of a given nursing home. A tremendous amount of information about individual nursing homes is online at Medicare’s website, including staffing levels, complaint histories and inspection reports. Medicare also offers a checklist you can use to ask the right questions during your investigations.

One other important resource is the National Citizen's Coalition for Nursing Home Reform (NCCNHR), which offers advice, support, and two important publications. "Nursing Homes: Getting Good Care There," now in its second edition, is an excellent guide for family members concerned about the quality of care in nursing homes. NCCNHR's "Consumer Guide to Choosing a Nursing Home" provides solid, detailed and practical advice on selecting a good nursing home.

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