Do residents have personal belongings decorating their rooms?
Does each resident have at least one comfortable chair?
Does each resident have his/her own dresser and closet space with a locked drawer or other secured compartment?
Is there an out-of-doors area where residents can walk or sit and is it used?
Does the equipment--wheelchairs, therapy devices--appear in good condition?
Is there a lounge or other area where residents can entertain visitors privately?

Safety

State standards require that a home provide a safe environment for residents whether they are mobile or in wheelchairs, whether they are confused or have poor eyesight. Look for:

handrails in hallways and other critical places;
wide, clear walking areas;
the absence of hazards that might cause accidents;
good lighting;
telephones and large print notices placed so that wheelchair-bound residents can make use of them;
appropriate inside temperature and whether or not residents are dressed appropriately;
clearly marked exits and well-lighted elevators.
Find out if the local fire department participates in fire drills and how often drills are held in the home. 

Cleanliness

A good home should be clean. Look in the corners of residents rooms, bathrooms, kitchens, nurses stations, etc., as well as in the main visiting lounges. Look for cleanliness EVERYWHERE.

Unpleasant odors reflect problems. If there is an odor in a particular section of the home, go back to see if it has been eliminated within a reasonable amount of time. This will give you an idea of how long it takes the home to deal with the cause of the unpleasant odor.

Residents

The average nursing home resident is old, sick and frail. A good home is aware that even frail elderly people can have good days and bad days and can be encouraged to be more active when they are feeling better and comforted when they are feeling poorly.

You may be able to judge how successful a home is in caring for residents by observing them without infringing on their privacy.

Do residents socialize with each other?
Is there activity in the corridors?
Are residents engaged in doing things or just sitting in a lounge or in the hallways?
Are residents neatly dressed and do they appear to be wearing their own clothing?
Are residents out of bed?
Do staff interact with residents in a warm and friendly manner?
Do staff address the residents by name?
Do staff respond to someone calling for help?
Are people assisted in walking for the purpose of exercising or retraining?

Ask several residents how they keep occupied and what they particularly like doing at the facility.

Room Assignments

Do residents share rooms? How many people to a room?
Does the facility try to select compatible roommates?
Are rooms assigned based on severity of illness?
How does the facility deal with problems between roommates?

Food

Mealtime is an important part of the residents day. Try to visit during meal time and observe the way food is served and how the staff and residents interact.

Is food appetizing and of good quality?
Do residents have an alternative to the main menu?
Are residents encouraged and assisted with eating (if necessary) while the food is served?
Is this a time when socializing is encouraged?
Is the dining room clean, attractive and colorful?

Many facilities try to be less "institutional" and use tablecloths, china and silver, enhancing mealtime.

Medical/Nursing Care

It is hard to observe medical/nursing practices, but you can ask questions:

Does the same nurse or aide care for the resident during each shift?
Will your family doctor be able to care for you in the facility?
If you do not have a private doctor, who will the physician be and what relationship will you or a family member have with this doctor?
How often will visits be made, and how will medical emergencies be handled?

If you need more than routine medical care, ask if a specialist can be called in and how this is done. Find out with which hospital(s) the nursing home may be affiliated. 

Special Therapies

If you might need speech, physical or special therapy, look at the therapy rooms. If possible, speak to the staff person in charge.
How frequently will therapy be offered?
Can therapies be provided on an optional basis or a for-private-pay basis?
Is the physician involved in assessing the therapy and your response to it?

Activities Program

All homes are required to offer activities for residents. As you visit homes, you may find a great difference in the way activities are offered. Ideally, a program should be designed to fit the interests and skills of each person and be available on a daily basis at various times of the day including weekends.

Ask if residents are taken out for events in the community. How often? Where do they go?
Do people in wheelchairs get to participate?
How often are outside events brought in for the entertainment of residents?
What activities are provided for bed-bound residents? 

Financial Arrangements

If you will be paying privately for care, ask about the fee schedule and be sure you find out what services and supplies ARE NOT INCLUDED and what these items will cost.

To determine how often fees increase, ask how often fees increased in the past and what the increases were. 
State Inspections

State law prohibits residents from being asked to pay more than three months in advance upon admission. (People admitted under Medicare do not have to pay anything in advance.)

The last state inspection report (survey) should be available to you in a place within the facility that is readily accessible. It will tell you if the facility failed to meet any areas of the states health code. Look for this report. If there are any deficiencies noted, specifically ask what steps have been taken to correct these violations.

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