50 Essential Questions to Ask When Visiting a Nursing Home

These questions address the core mission of a nursing home — providing safe, competent, compassionate care:

1. What is the ratio of direct-care staff to residents on each shift? Get specific numbers for day, evening, and night shifts. A ratio of 1 CNA to 8-10 residents during the day is reasonable; 1 to 15+ is concerning.
2. Is there a registered nurse (RN) on-site 24 hours a day, 7 days a week? Federal law only requires an RN for 8 hours per day. Facilities with 24/7 RN coverage provide a higher level of clinical oversight.
3. How does the facility handle medical emergencies at night? Who responds first? How quickly can a physician be reached? Is there a protocol for when to call 911 vs. manage on-site?
4. What is the facility's hospitalization rate? A high rate may indicate inadequate on-site care. A very low rate may indicate the facility avoids necessary transfers.
5. How are care plans developed and updated? Federal law requires an individualized care plan for every resident, updated quarterly and whenever there is a significant change. Ask to see a sample (de-identified) care plan.
6. How does the facility manage pain? Ask specifically about their assessment tool, how often pain is assessed, and their philosophy on medication vs. non-pharmacological approaches.
7. What is the facility's policy on antipsychotic medications? Antipsychotic use in nursing home residents without a qualifying psychiatric diagnosis is a key CMS quality measure. Ask what percentage of residents receive antipsychotics and how they compare to the state average.
8. How does the facility handle dementia care? Is there a dedicated memory care unit? What specialized training does staff receive? How are behavioral symptoms managed?

Staffing is the single most important predictor of care quality. These questions dig deeper than the numbers:

9. What is the total nursing staff turnover rate? CMS publishes this data, but ask the facility directly. Total nursing turnover above 50% annually suggests significant instability. RN turnover above 40% is concerning.
10. How long has the current Director of Nursing been in this position? A DON who has been in place for 2+ years indicates leadership stability. A facility that has had 3 DONs in 2 years has systemic problems.
11. How long has the current administrator been here? Same logic. Administrator stability correlates with consistent quality.
12. What ongoing training do CNAs receive beyond the initial certification? Look for facilities that invest in continuing education — dementia care, wound prevention, fall prevention, communication skills.
13. Are CNAs assigned to consistent resident groups? Consistent assignment means the same aides care for the same residents, building relationships and enabling early detection of changes. This is a best practice endorsed by CMS.
14. What is the facility's process for background checks on staff? Federal law requires checks against the state nurse aide registry. Ask whether the facility also conducts criminal background checks, and for which employee categories.
15. How does the facility handle call lights? What is the target response time? How is it measured? Ask to observe call light response during your visit.
16. Are there enough staff on weekends and holidays? Ask specifically what the staffing level is on Saturday and Sunday compared to weekdays. Check CMS weekend staffing data on our facility pages.

Safety questions are especially important and often overlooked by families:

17. How many falls occurred in the facility last quarter? All facilities track falls. A transparent facility will share this number. Ask also about falls with injury — the more serious metric.
18. What is the facility's fall prevention program? Look for specific interventions: bed alarms, low beds, non-slip flooring, exercise programs, medication review for fall-risk drugs.
19. What is the facility's infection control program? After COVID-19, this is critical. Ask about hand hygiene compliance rates, isolation protocols, antibiotic stewardship, and vaccination rates among staff and residents.
20. How does the facility prevent and manage pressure ulcers? Ask about turning schedules, pressure-relieving mattresses, nutrition protocols, and the current prevalence of pressure ulcers.
21. Is the building equipped with a sprinkler system? Not all older facilities have full sprinkler coverage. CMS tracks fire safety deficiencies — check the inspection reports.
22. What is the facility's emergency preparedness plan? Ask specifically about evacuation plans, backup power, water supply, and medication supply during extended emergencies.
23. How does the facility manage residents who wander? For dementia patients, wandering management is a safety-critical issue. Ask about door alarms, GPS tracking, secured units, and staffing in memory care areas.
24. What security measures are in place? Who can access the building? How are visitors tracked? What measures prevent unauthorized removal of a resident?

Quality of life encompasses everything beyond medical care — the factors that make daily life bearable, enjoyable, or miserable:

25. Can I see the weekly menu? Look for variety, fresh food, cultural options, and seasonal changes. Ask whether residents can choose between two or more entrees at each meal.
26. How does the facility accommodate dietary restrictions and preferences? Vegetarian, kosher, halal, diabetic, pureed, thickened liquids — a good facility accommodates all of these as a matter of course.
27. Can I eat a meal here today? The best way to judge food quality is to eat it. A facility that discourages this is hiding something.
28. What does the weekly activity calendar look like? Ask to see it. Look for variety — physical, social, cognitive, creative, spiritual. Ask whether activities happen on weekends and evenings, or only during weekday business hours.
29. How are residents who cannot participate in group activities engaged? Bed-bound or cognitively impaired residents deserve individualized engagement. Ask what happens for these residents specifically.
30. Is there an outdoor space accessible to residents? Access to fresh air and nature is linked to better mood, sleep, and behavior in nursing home residents.
31. What is the facility's policy on personal belongings? Can residents bring their own furniture, photos, televisions? A facility that restricts personalization of rooms prioritizes its own convenience over residents' emotional needs.
32. How does the facility accommodate cultural and religious practices? Ask about chaplain services, religious observances, cultural food options, and translation services.
33. Can residents keep pets or receive pet visits? Animal-assisted therapy is evidence-based for improving mood and reducing agitation, especially in dementia.
34. What transportation is available for medical appointments or community outings?

Financial transparency is a hallmark of a trustworthy facility:

35. What is the all-inclusive daily or monthly rate? Get a specific number, in writing, for the room type your family member will occupy.
36. What services are NOT included in the base rate? Common add-ons include: beauty/barber services, phone/cable, personal laundry, specialized therapies, and medical supplies. These can add $200-$500/month.
37. How much notice is required for rate increases, and how often do they occur? Ask for the history of rate increases over the last 3 years. Annual increases of 3-5% are typical; increases above 8% are aggressive.
38. Does the facility accept Medicaid? If your family member may eventually need Medicaid, this is critical. About 70% of nursing homes accept Medicaid, but some do not, and some accept Medicaid only for existing residents who have spent down.
39. If my family member starts as private pay and transitions to Medicaid, what happens? Will they keep the same room? The same bed? Some facilities move Medicaid residents to less desirable rooms or locations.
40. What are the discharge conditions in the admission contract? Under what circumstances can the facility discharge a resident involuntarily? Common conditions include nonpayment, safety risks to others, and the facility's inability to meet the resident's care needs.
41. Is there a mandatory arbitration clause in the admission agreement? Many facilities include arbitration clauses that waive the right to sue. CMS has gone back and forth on whether these can be required. You generally have the right to refuse arbitration.
42. Can I take the admission agreement home to review before signing? Any facility that pressures you to sign immediately during the tour should be viewed with caution. Take it home and have an elder law attorney review it.

Federal law guarantees nursing home residents specific rights. These questions test whether the facility respects them:

43. How does the facility involve families in care plan meetings? Ask how often care plan meetings are held, how much advance notice families receive, and whether meetings can be scheduled around family availability (including evening or phone options).
44. What is the facility's grievance process? Every facility must have a formal grievance process. Ask who handles complaints, what the response timeline is, and how complaints are tracked and resolved.
45. Can I visit at any time? Federal regulations guarantee reasonable visitation rights. A facility that restricts visits to "business hours" or requires appointments for family visits is violating this right (infection control exceptions aside).
46. What is the policy on roommate conflicts? In semi-private rooms, roommate compatibility matters enormously. Ask how the facility handles requests for room changes or roommate conflicts.
47. How does the facility protect residents' personal funds? If the facility manages a resident's personal funds (common for Medicaid residents), there are strict federal requirements for accounting and access. Ask how residents access their funds and how accounts are audited.
48. Who is the long-term care ombudsman for this area, and how often do they visit? Every state has an ombudsman program that advocates for nursing home residents. A facility that knows and welcomes their ombudsman is more likely to respect resident rights.
49. What is the policy on the use of physical restraints? CMS has worked to reduce restraint use, and the national average is now below 1%. A facility that uses restraints on more than 2% of residents is an outlier that warrants investigation.
50. May I speak privately with a current resident or family member? A confident facility will welcome this. If the facility arranges a clearly staged conversation with a selected family, that tells you something too.

After visiting 2-3 facilities with this questionnaire, you will have a detailed comparison grid. Here is how to weigh the answers:

• Non-negotiables: 24/7 RN coverage, Medicaid acceptance (if needed), no immediate jeopardy citations, willing to let you visit freely, transparent about staffing data and inspection results.
• Strong differentiators: Consistent CNA assignment, low staff turnover, family-friendly care planning process, strong activity programming, good food quality.
• Nice-to-haves: Pet therapy, private rooms, beauty salon, transportation services, cultural programming.

The single most important thing you can observe is the culture: do staff seem genuinely caring, or are they going through the motions? Do residents seem engaged and clean, or withdrawn and unkempt? Does management answer hard questions honestly, or deflect with marketing language?

Combine your visit observations with the data on CareFindPeek — star ratings, staffing hours, inspection results, and quality measures — for the most complete picture. Trust your instincts, but verify them with data.