Nursing Home Checklist

Checklists can help you evaluate the nursing homes that you call or visit. Use a new checklist for each home you call or visit. Then, compare the scores. This will help you select a nursing home that is a good choice for you or your relative.

Nursing Home Name: ___________________________________

Date Visited: __________________________

Address: ______________________________________________

1. Is the facility Medicare certified?:____(yes) _____(no)

2. Is the facility Medicaid certified?:____(yes) _____(no)

3. Is this a skilled nursing facility?:____(yes) _____(no)

4. Is the facility accepting new patients?:____(yes) _____(no)

5. Is there a waiting period for admission?:____(yes) _____(no)

6. Is a skilled bed available to you?:____(yes) _____(no)

Useful Tips

• Generally, skilled nursing care is available only for a short period of time after a hospitalization. Custodial care is for a much longer period of time. If a facility offers both types of care, learn if residents may transfer between levels of care within the nursing home without having to move from their old room or from the nursing home.
• Nursing homes that only take Medicaid residents might offer longer term but less intensive levels of care. Nursing Homes that don't accept Medicaid payment may make a resident move when Medicare or the resident's own money runs out.
• An occupancy rate is the total number of residents currently living in a nursing home divided by the home's total number of beds. Occupancy rates vary by area, depending on the overall number of available nursing home beds.

1. Is the home and the current administrator licensed?:
      ____(yes) _____(no)

2. Does the home conduct background checks on all staff?:
      ____(yes) _____(no)

3. Does the home have special services units?:
      ____(yes) _____(no)

4. Does the home have abuse prevention training?:
      ____(yes) _____(no)

Useful Tips

• LICENSURE: The nursing home and its administrator should be licensed by the State to operate.
• BACKGROUND CHECKS: Do the nursing home's procedures to screen potential employees for a history of abuse meet your State's requirements? Your State's Ombudsman program might be able to help you with this information.
• SPECIAL SERVICES: Some nursing homes have special service units like rehabilitation, Alzheimer's, and hospice. Learn if there are separate waiting periods or facility guidelines for when residents would be moved on or off the special unit.
• STAFF TRAINING: Do the nursing home's training programs educate employees about how to recognize resident abuse and neglect, how to deal with aggressive or difficult residents, and how to deal with the stress of caring for so many needs? Are there clear procedures to identify events or trends that might lead to abuse and neglect, and on how to investigate, report, and resolve your complaints?
• LOSS PREVENTION: Are there policies or procedures to safeguard resident possessions?

For Sections III through VI, give the nursing home a grade from one to five. One is worst, five is best.

1=Worst      5=Best

1. Residents can make choices about their daily routine. Examples are when to go to bed or get up, when to bathe, or when to eat.
            1     2     3     4     5

2. The interaction between staff and patient is warm and respectful.
            1     2     3     4     5

3. The home is easy to visit for friends and family.
            1     2     3     4     5

4. The nursing home meets your cultural, religious, or language needs.
            1     2     3     4     5

5. The nursing home smells and looks clean and has good lighting.
            1     2     3     4     5

6. The home maintains comfortable temperatures.
            1     2     3     4     5

7. The resident rooms have personal articles and furniture.
            1     2     3     4     5

8. The public and resident rooms have comfortable furniture.
            1     2     3     4     5

9. The nursing home and its dining room are generally quiet.
            1     2     3     4     5

10. Residents may choose from a variety of activities that they like.
            1     2     3     4     5

11. The nursing home has outside volunteer groups.
            1     2     3     4     5

12. The nursing home has outdoor areas for resident use and helps residents to get outside.
            1     2     3     4     5

IV. TOTAL: _____________ (Best Possible Score: 60)

1=Worst      5=Best

1. The facility corrected any Quality of Care deficiencies that were in the State inspection report.
            1     2     3     4     5

2. Residents may continue to see their personal physician.
            1     2     3     4     5

3. Residents are clean, appropriately dressed, and well groomed.
             1     2     3     4     5

4. Nursing Home staff respond quickly to requests for help.
            1     2     3     4     5

5. The administrator and staff seem comfortable with each other and with the residents.
            1     2     3     4     5

6. Residents have the same care givers on a daily basis.
            1     2     3     4     5

7. There are enough staff at night and on week-ends or holidays to care for each resident.
            1     2     3     4     5

8. The home has an arrangement for emergency situations with a nearby hospital.
            1     2     3     4     5

9. The family and residents councils are independent from the nursing home's management.
            1     2     3     4     5

10. Care plan meetings are held at times that are easy for residents and their family members to attend.
            1     2     3     4     5

VI. TOTAL: _____________ (Best Possible Score: 50)

• Good care plans are essential to good care. They should be put together by a team of providers and family and updated as often as necessary.

1=Worst      5=Best

1. The home corrected any deficiencies in these areas that were on the recent state inspection report.
            1     2     3     4     5

2. There are enough staff to assist each resident who requires help with eating.
            1     2     3     4     5

3. The food smells and looks good and is served at proper temperatures.
            1     2     3     4     5

4. Residents are offered choices of food at mealtimes.
            1     2     3     4     5

5. Residents' weight is routinely monitored.
            1     2     3     4     5

6. There are water pitchers and glasses on tables in the rooms.
            1     2     3     4     5

7. Staff help residents drink if they are not able to do so on their own.
            1     2     3     4     5

8. Nutritious snacks are available during the day and evening.
            1     2     3     4     5

9. The environment in the dining room encourages residents to relax, socialize, and enjoy their food.
            1     2     3     4     5

IX. TOTAL: _____________ (Best Possible Score: 45)

Useful Tips

• Ask the professional staff how the medicine a resident takes can affect what they eat and how often they may want something to drink.
• Visit at mealtime. Are residents rushed through meals or do they have time to finish eating and to use the meal as an opportunity to socialize with each other?
• Sometimes the food a home serves is fine, but a resident still won't eat. Nursing home residents may like some control over their diet. Can they select their meals from a menu or select their mealtime?
• If residents need help eating, do care plans specify what type of assistance they will receive?

1=Worst      5=Best

1. There are handrails in the hallways and grab bars in the bathrooms.
            1     2     3     4     5

2. Exits are clearly marked.
            1     2     3     4     5

3. Spills and other accidents are cleaned up quickly.
            1     2     3     4     5

4. Hallways are free of clutter and have good lighting.
            1     2     3     4     5

5. There are enough staff to help move residents quickly in an emergency.
            1     2     3     4     5

6. The nursing home has smoke detectors and sprinklers.
            1     2     3     4     5

XI. TOTAL: _____________ (Best Possible Score: 30)

Nursing Home Compare contains summary information about nursing homes from their last state inspection. It also contains information that was reported by the nursing homes prior to the last State inspection including nursing home and resident characteristics. If you have questions or concerns about the information on a nursing home, you should discuss them during your visit. This section contains useful tips and questions that you may want to ask the nursing home staff, family members and residents of the nursing home during your visit.

1. Nursing Home Compare Information on Results of Nursing Home Inspections

• Bring a copy of the Nursing Home Compare inspection results for the nursing home. Ask whether the deficiencies have been corrected.
• Ask to see a copy of the most recent nursing home inspection report. Nursing Home Compare Information on Resident and Nursing Home Characteristics.

2.For the Measure: Residents with Physical Restraints

• Does it appear that there is sufficient staff to assist residents who need help in moving or getting in and out of chairs and bed?
• Ask the Director of Nursing who is involved in the decisions about physical restraints.
• When physical restraints are used, do the staff remove the physical restraints on a regular basis to help residents with moving, and with activities of daily living?
• Do the staff help residents with physical restraints to get in and out of bed and chairs when they want to get up?
• Do staff help residents with physical restraints to move as much as they would like to?

3. For the Measure: Residents with Pressure (Bed) Sores

• Ask the staff how they identify if a resident is at risk for skin breakdown. Ask them what they do to prevent pressure sores for these residents.
• Ask the staff about the percentage of their residents that have pressure sores and why.
• Do you see staff helping residents change their positions in wheelchairs, chairs, and beds?

4. For the Measure: Residents with Bowel and Baldder Incontinence

• Does the nursing home smell clean?
• Ask the staff what steps they take to prevent bowel and bladder incontinence for residents who are at risk.

5. For the Measure: Residents Who Are Very Dependent in Eating

• Look at your response to Question 2 in Section V above.
• Observe residents who need help in eating. Are they able to finish their meals or is the food returned to the kitchen uneaten?

6. For the Measure: Residents Who Are Bedfast

• Ask the Director of Nursing how staff are assigned to care for these residents.

7. For the Measure: Residents With Restricted Joint Motion

• Ask the Director of Nursing how the nursing home cares for residents with restricted joint motion.
• Do the residents get help with getting out of chairs and beds when they want to get up?

8. For the Measure: Residents with Unplanned Weight Gain or Loss

• Look at your responses to Questions 2, 3, 4, 5, 8, and 9 in section V above.

9. For the Measure: Residents with Behavioral Symptoms

• What management and/or medical approaches for behavioral symptoms are being used by the nursing home?
• How does staff handle residents that have behavioral symptoms such as calling out or yelling?
• Ask whether residents with behavioral symptoms are checked by a doctor or behavioral specialist.
• Ask whether staff get special training to help them to provide care to residents with behavioral symptoms.

Caring, competent nursing staff who respect each resident and family member are very important in assuring that residents get needed care and enjoy the best possible quality of life. Adequate nursing staff is needed to assess resident needs, plan and give them care, and help them with eating, bathing and other activities. Some residents (e.g., those who are more dependent in eating or who are bedfast) need more help than other residents depending on their conditions.

The combinations of registered nurses (RNs), licensed practical and vocational nurses (LPNs/LVNs), and certified nursing assistants (CNAs)that nursing homes may have vary depending on the type of care that residents need and the number of residents in the nursing home.

10.Look at your responses to Questions 2 and 5 in section III above and Questions 4, 5, and 10 in section IV above. Also look at your responses to Questions 2 and 7 in section V above.

11.Are nursing staff members courteous and friendly to residents and to other staff?

12.Do nursing staff respond timely to residents calls for assistance such as help getting in and out of bed, dressing and going to the bathroom?

13.Observe meal times. Do all residents who need assistance with eating get help? Do staff give each resident enough time to chew food thoroughly and complete the meal?

14.Which nursing staff members are involved in planning the residents individual care? (Are they the same ones who give the care to residents?)

15.Ask questions about staff turnover. Is there frequent turnover among certified nursing assistants (CNAs)? What about nurses and supervisors, including the Director of Nursing and the Administrator? If staff changes frequently, ask why

• Nursing Home Malpractice
• Nursing Home Checklist
• OBRA
• Government Regulation of Nursing Homes
• Recent Jury Verdicts/Settlements in Nursing Home Cases Around the Country