How to choose a skilled nursing facility

Ken Schonbachler is CEO of the Rouse Estate.

Although many different levels and settings exist today to meet the care needs of our aging population, skilled nursing facilities may be the best known, for both good and bad reasons. People go to nursing homes for different purposes, including if they’re sick, hurt, had surgery and need to get better, or have chronic care needs or disabilities that require ongoing nursing or rehabilitative care. Regardless of the need or reason for a nursing home stay, there are four basic steps that the Centers for Medicare and Medicaid Services (CMS) recommend when choosing the right facility.

Step One is to find nursing homes in your area. There are many ways that you can learn about the different nursing homes in your area, including asking family, friends, or neighbors about facilities that they themselves or someone they know has utilized. You can also ask your physician if there are any nursing homes that they recommend, or perhaps even that they may see patients in, which would be an advantage for your continuity of care. Another great resource, and possibly the most informative, is to visit the CMS website Nursing Home Compare ( If you are in the hospital then the social worker or discharge planner should be able to provide you with a list of nursing homes in your area. Make sure that you ask them as early in your hospital stay as possible in order to make the transfer as smooth as possible. Finally, your local senior and community activity center may be able to provide you with nursing home information for your community.

Step Two is to compare the quality of the nursing homes that you may be considering. CMS’ Nursing Home Compare website is invaluable when it comes to see current and historical data regarding the quality of a skilled nursing facility. CMS requires participating in nursing homes to submit quality data on over thirty items. The site also allows you to compare facility scores with state and national averages. CMS ranks nursing homes on a one to five-star scale based on the department of health survey results, staffing levels, and quality of care data. On the nursing home compare website you are able to view the facilities overall star ranking, as well as the star rating for these components which make up the overall ranking. Additionally, you can compare the quality data between facilities and even pick certain measures that may be of higher importance to you. For example, if you are interested in rehabilitation services, you can look at the quality measures for improvement in the ability to move around on your own, the percentage of residents successfully discharged to home or the inclusion of functional goals in residents’ care plans. If you are interested in long term care, measures such as the percentage of long-stay residents who developed pressure ulcers or the number of emergency department visits per 1,000 long-stay resident days may be more helpful to evaluate.

Step Three is to visit or have someone you trust visit, the nursing homes you have selected as having high potential. It’s best to visit the nursing homes that interest you before you make a final decision on which one meets your needs. A visit gives you the chance to see the residents, staff, and the nursing home setting. It also allows you to ask questions of the nursing home staff and talk with residents and their family members. If you can’t visit the nursing home yourself, ask a family member or friend to visit for you. You can also call for information, but a visit can help you see the quality of care and life of the actual residents. For a checklist of things to look for when you visit a nursing home, a publication by CMS entitled “Your Guide to Choosing a Nursing Home or Other Long-Term Services and Supports” offers a very helpful guideline. This publication can be found at

Step Four is to choose the nursing home that best meets your needs. When you have all the information that is important to you, talk with people who understand you, your personality, and your personal health needs. This can include your family, friends, neighbors, or even doctors, spiritual advisor and social workers. If you are helping someone else decide, be certain to consider and keep their values and preferences in mind.

An additional factor which may be important is to ask whether a facility offers a breadth of services for long term support. Some organizations may offer personal care, home care, outpatient services, support groups and/or adult day care services in addition to the skilled nursing facility. By offering a range of care and support levels, an organization is able to communicate and coordinate your care and support needs in a more efficient and effective manner. Additionally, organizations may be able to guarantee care or transfers between different care levels offered by the organization, ensuring that the right level of support and service is available to match any changing care needs.

Whether you are in current need of long or short term care and support or are just planning for future needs for you or a loved one, the CMS publication “Your Guide to Choosing a Nursing Home or Other Long-Term Services and Supports” is a valuable resource. The guide also covers topics such as payment, alternative services, what to expect upon admission, and how to register complaints.

This article brought to you by the Eldercare Council of Forest-Warren Counties. Ken Schonbachler is CEO of the Rouse Estate.