How to choose a nursing home: check the ratings, visit twice, and ask the right questions
This guide is general educational information, not medical, legal, or financial advice. Talk with your own attorney, financial advisor, or care professional about your situation. Elder Living Guide provides education and referrals; we are not a care provider, facility, agency, or medical practice.
Short answer: Start with what your parent needs now and may need later, then shortlist Medicare- and Medicaid-certified homes on Medicare's Care Compare, which gives each one an overall rating of 1 to 5 stars plus separate ratings for health inspections, staffing and quality measures. CMS itself warns that no rating system covers everything that matters, such as specialty care or how easy it will be for family to visit (CMS: Five-Star Quality Rating System), so use the stars to decide which questions to ask, not to make the choice. Then visit each home at least twice, once without calling ahead, and bring Medicare's nursing home checklist.
This page puts the official advice from the National Institute on Aging (NIA), the Centers for Medicare & Medicaid Services (CMS) and the Administration for Community Living (ACL) in one order you can follow, with a free comparison sheet. It doesn't rate or recommend any nursing home.
Is a nursing home the right setting?
NIA says it may be time to consider a residential facility when an older person needs more help than a family member or friend can provide, and it describes assisted living as for people who need help with daily care, but not as much help as a nursing home provides (NIA: long-term care facilities). If you're still deciding between settings, read assisted living vs nursing home first. Also be clear about which kind of stay you're planning. A short stay for recovery after a hospital stay and a long-term stay are paid for very differently: Medicare covers skilled nursing facility care only for a limited time and only after a qualifying hospital stay, and it doesn't pay for long-term care (see what Medicare covers in a skilled nursing facility). If a home offers both, ask which kind of stay you're being quoted for.
Write down needs and wants first
NIA suggests two lists before you look at any home (NIA: how to choose a nursing home or other long-term care facility):
- Services needed now and later. For example, help with everyday activities, physical therapy, nursing care, hospice care, or a special unit for people with memory problems or dementia. If you're unsure, NIA suggests asking a health care provider which services may help most.
- Features that matter to the person. For example, meals, social and recreational activities, a religious connection, or staying close to family and friends so they can easily visit.
Our suggestion: put both lists on one page and bring it to every visit, so each home is measured against your parent, not against the last home you saw.
Build a shortlist
NIA suggests asking friends and family about their experience with particular facilities, and says health care providers, social workers, religious groups and support groups in your community may also be able to suggest good places. For a list of nearby homes, use Medicare's Care Compare. To find local services such as your Area Agency on Aging, use the Eldercare Locator, a public service of ACL.
Then contact each home on the list. NIA suggests asking how many people live there and what it costs, mentioning any special needs or preferences, and finding out whether there's immediate availability or a waiting list. Medicare's checklist adds a basic first question: is the home Medicare-certified and Medicaid-certified? "Certified" means the home passed an inspection by a state government agency, and Medicare and Medicaid only cover care from certified nursing homes (Medicare checklist, CMS-12130).
What Care Compare's star ratings tell you, and what they don't
CMS created the Five-Star Quality Rating System to help families compare nursing homes and to help identify areas you may want to ask about. On Care Compare each nursing home gets one overall rating of 1 to 5 stars, plus separate ratings for health inspections, staffing and quality measures. Homes with 5 stars are considered to have much above average quality, and homes with 1 star much below average (CMS).
CMS also puts a caution on its own ratings. No rating system can address everything that goes into choosing a home for a particular person, such as how much specialty care is offered (specialized rehabilitation or dementia care, for example) or how easy it will be for family to visit. Because visits can improve both residents' quality of life and quality of care, CMS says it may be better to choose a home that's very close over one rated higher but far away. It tells families to use the website together with other information, including a visit to the home and state or local organizations such as the State Ombudsman program.
How we'd use the stars (our suggestion): write down all four ratings for each home on your sheet. A low rating in one area doesn't rule a home out by itself, but it tells you which questions to ask first on the visit, for example about staffing if the staffing rating is low.
Read the inspection report
A star rating is a summary; the inspection report shows what inspectors found. Medicare's checklist says a nursing home must make its most recent state or federal survey report available in a public place, and that you can also find it, and older reports, on Care Compare and on most state survey agency websites. The report tells you how well the home meets federal health and safety rules. The checklist suggests asking:
- Does the inspection report show quality-of-care problems or other citations (failure to meet one or more state or federal requirements)?
- Has the home corrected all citations on its last state inspection report? If an issue concerns you, ask what the home has done or is doing to correct it.
- Has the home been cited for issues related to abuse in the last year or two? Medicare's checklist notes that nursing homes cited for abuse have an icon next to their name on Medicare.gov.
Visit twice, once without calling ahead
NIA suggests visiting several homes in person before deciding, meeting the director, nursing director or other key staff, and taking a copy of Medicare's checklist to fill out at each one. On the first visit, NIA suggests looking for:
- Medicare and Medicaid certification, and state licensing
- Accessibility for people with disabilities
- Residents who look appropriately dressed and well cared for
- Warm and respectful interaction between staff and residents
- A clean, fresh-smelling, comfortable and well-maintained building
Then make a second visit without calling ahead, on another day of the week or at another time of day, so you meet other staff and see different activities. NIA also suggests stopping by at mealtime: is the dining room attractive and clean, does the food look appetizing, and can you sample it? Medicare's checklist adds things to notice on any visit, such as comfortable temperature and lighting, noise levels in the dining room and common areas, clearly marked exits, handrails and grab bars, and quiet areas for visiting with family.
If you've already toured assisted living, our assisted living tour checklist covers what to bring; the same folder works here.
Questions to ask
Medicare's checklist runs to eight pages of questions. These are a shorter set, grouped by topic, taken from that checklist (marked Medicare) and from NIA's guide (marked NIA). Questions are paraphrased lightly; the source documents have the full wording.
| Topic | Question | From |
|---|---|---|
| Basics | Is the home Medicare-certified? Medicaid-certified? What state agency licensed the home and its administrator? | Medicare |
| Basics | Are there any openings? Are there extra charges for other services, like beauty shop services? | Medicare |
| Basics | Will the home tell you in writing about its services, charges and fees before move-in? (Medicare's checklist says certified homes must, and suggests getting the fee schedule to see what the monthly fee includes and what costs extra.) | Medicare |
| Safety and care | What are the home's overall, health inspection, staffing and quality measure ratings on Care Compare, and what is it doing to improve quality and staffing? | Medicare |
| Safety and care | Can my parent still see their own doctor, and does the home help with transportation for that? What hospitals does the home have arrangements with? | Medicare |
| Safety and care | How will residents get oral care and mental health care? Are eye doctors, ear doctors and podiatrists available, or does the home help arrange them? | Medicare |
| Safety and care | How will the home inform residents and families about its emergency and disaster plan? What happens during an infectious disease outbreak that requires quarantine? | Medicare, NIA |
| Preventing abuse | How does the home check that it doesn't hire staff with a finding or history of abuse, neglect or mistreatment in the state nurse aid registry? What are its policies on preventing and reporting abuse and neglect, and how does it respond to concerns? | Medicare |
| Staff | How many nurses, including certified nurse aides, are available during the day, at night and on weekends? (Medicare's checklist notes the home is required to post this.) Will the same staff care for my parent day to day? | Medicare |
| Staff | How long have the director and the heads of nursing, food and social services worked here? How often do key staff members turn over? Is there a doctor who checks on residents regularly, and how often? | NIA |
| Rooms | Is a private room available? If my parent needs Medicaid in the future, will they still be able to have a private room? How much of their own furniture and belongings can they bring? | Medicare |
| Daily life | Can residents decide when to get up, go to sleep or bathe? Are there outdoor areas, and is staff available to help residents go outside? How do residents who can't leave their rooms take part in activities? | Medicare |
| Food | Is there a choice of food at each meal? Can the home meet individual dietary needs, and can staff help residents eat and drink if needed? | Medicare |
| Dementia care | Does the home have dementia care policies that try non-medication approaches first for behavioral symptoms? Has staff had extra dementia training? What's the home's current rate of antipsychotic medication use? | Medicare |
| Resident or family group | If you can attend a resident or family group meeting: what did the home change in the last year to improve residents' quality of life, and how has it responded to the group's recommendations? | Medicare |
If your parent has dementia, our memory care tour guide has more questions about specialized units.
Talk to the long-term care ombudsman
Every state has a Long-Term Care Ombudsman program. ACL says these programs work to resolve problems related to the health, safety, welfare and rights of people who live in long-term care facilities such as nursing homes, and that each state has an Office of the State Long-Term Care Ombudsman (ACL: Long-Term Care Ombudsman Program). CMS also names the State Ombudsman program as a source to use alongside Care Compare. Your state's program is a good place to ask about residents' rights or a concern you noticed on a visit; you can find it through the Eldercare Locator. Our tour checklist has more on who to ask outside a facility.
Costs and the admission agreement
NIA's advice: get detailed information about costs and which services are included, find out whether Medicare, Medicaid or long-term care insurance will pay for any of the costs, and ask whether the facility has a financial office that can help you see what assistance is available. Once you choose a home, read the contract carefully, ask about anything you don't understand, and read it again before signing.
- For who pays for what, see Medicaid and long-term care in our paying-for-care guide.
- Our guide to reading an assisted living contract shows a way to work through any care agreement section by section. Nursing home agreements are a different document under different rules, so use it as a reading method, not as a description of nursing home terms, and ask the ombudsman program or your own attorney about anything that worries you.
Free side-by-side comparison sheet
Download the free nursing home comparison sheet (CSV). It has one row per home and columns for certification, the four Care Compare ratings, whether the last inspection's citations were corrected, the abuse icon, both visit dates, openings or a waiting list, a private room if Medicaid pays later, and notes. It opens in Excel, Google Sheets or Numbers, and it's blank: no home names, no ratings.
Made-up example
Made-up example (not a real family or real nursing homes). A family compared two certified homes after their father's hospital stay:
| On the sheet | Home A (40 minutes away) | Home B (10 minutes away) |
|---|---|---|
| Overall rating | 5 stars | 4 stars |
| Staffing rating | 4 stars | 3 stars |
| Last inspection citations corrected? | Yes | Yes, one still being fixed; they explained the plan |
| Unannounced visit | Not done yet | Done at dinner; calm dining room, staff knew residents by name |
| Private room if Medicaid later? | "Depends on availability" | "Depends on availability" |
The family didn't pick by stars. They booked the unannounced visit at Home A, asked Home B for its posted night and weekend staffing, and talked about how often each of them could realistically visit a home 40 minutes away, the trade-off CMS itself mentions.
Next steps
- Plan the move with our timeline for moving a parent into care.
- See where this fits in the whole process in our senior care planning guide.
- Read how Elder Living Guide works, or contact Elder Living Guide with a question.
How this page is made
Carter Hockinson, the editor of Elder Living Guide, built this guide from the National Institute on Aging's guide to choosing a long-term care facility and its overview of long-term care facilities, the CMS Five-Star Quality Rating System page, Medicare's nursing home checklist (CMS-12130, November 2022) and ACL's Long-Term Care Ombudsman Program page. All five were checked on October 20, 2026, and each fact is cited where it appears. The order of steps, the advice on using the stars, the comparison sheet and the example are our suggestions, labeled as ours; the example uses made-up homes and ratings. We didn't visit any nursing home for this page and don't rate or recommend one. Rules and programs differ by state, so check with your state's survey agency and ombudsman program.
Keep reading: Types of senior care compared · How families pay for senior care · Senior care planning: the complete family guide
Elder Living Guide provides education and referrals. We are not a care provider, facility, agency, or medical practice.