Information for Caregivers about Nursing Home Licensing & Regulations

Alzheimer's caregivers should check to make sure that the nursing home meets basic safety requirements. The home and its administrator should have current licenses from the state, and the facility should meet state fire regulations, which include sprinkler systems and fire doors.

Nursing Home Care & Services

It is important for the nursing home staff to be familiar with common issues arising from dementia. Ask whether the staff is continually trained in dementia care, what kinds of programs are offered to the residents, how individual care plans are developed, and how different levels of functioning are supported. Give specific examples of behaviors or challenges caused by Alzheimer's to find out how difficult situations might be handled. Be sure the facility provides for the special needs of each resident.

Other possible questions include the following:

  • Does the facility have its own physician? How are other medical, dental, and vision needs met?
  • Can the home accommodate any improvement or deterioration in a resident's condition? Under what circumstances would the home discharge the person, and how much notice would be given?
  • What is the home's policy regarding life-sustaining measures? Although this is a painful subject to discuss at the time of the patient's admission, it is generally important to record in the resident's chart the wishes of the family and resident regarding end-of-life care.

Nursing Home Staff

Talk with the staff members who work directly with residents to see if they are competent, friendly, and content in their jobs. Observe how residents are treated and whether they receive help when they ask for it. Also, meet with the administrator and directors of nursing and social services. They will be able to tell you such things as the number of people each aide must take care of and how the facility is staffed on weekends and in the evenings.

Nursing Home Costs

Because nursing home care is expensive, it is important that all costs are clearly outlined and understood before making a decision. Address how costs will be met and whether paying for them will create a financial burden for family members. Because the laws regarding payment for nursing home care can be complex and vary from state to state, be sure to contact a reliable source for accurate information. The Alzheimer's Association, insurance companies, attorneys who specialize in financial planning, Medicare representatives, and some staff members of in-home care programs may be well informed on payment options.

Important questions to ask include the following:

  • Does the home accept the patient's funding sources (for example, Medicare)?
  • Will the resident receive a refund of advance payments if he or she leaves the facility?
  • How does the home protect cash and assets that are entrusted to it? How are withdrawals noted to keep track of the account?
  • What charges are extra (for example, television, telephone, laundry, personal-care supplies, special nursing procedures)?

Nursing Home Cleanliness and Safety

Be sure the nursing home is clean and safe, especially the kitchen and bathroom. Note unpleasant odors, such as mold, garbage, or urine. Odors that persist on return visits may indicate poor patient care or poor housekeeping. Make sure that the bathrooms have handrails and nonskid floors, the furniture is sturdy, the doors to the outside are secure, and the facility protects the safety of people who wander.

Nursing Home Comfort

Spend time observing everyday life and how people are treated in a variety of facilities. Ask residents and visitors about their opinions of the facility and its staff. Notice whether the residents look happy, comfortable, relaxed, and involved in activities. Ask yourself these questions:

  • Is the facility relatively quiet, well lit, and pleasant to be in?
  • Is there a well-planned indoor or outdoor walking path?
  • Are there familiar elements in the environment, such as home-like lighting and furnishings, a center of activity, a separate dining room, and areas in the resident's room that can be personalized?
  • Does the facility avoid disorienting sensory stimuli, such as overhead speaker systems, loud alarms, and blaring televisions?

Visiting Nursing Home Residents

Be sure the home is close enough so that family members can visit regularly. Confirm that the home has convenient visiting hours and that the resident can have privacy with visitors.

Nursing Home Meals and Activities

Check whether the food is wholesome, appealing, adequate, and suitable for older persons. Find out which services and activities are included in the fee. You should ask if participation in activities is required and what is done if a resident does not like the food or the activities.

Finally, make sure there are creative and effectively planned social activities in addition to supervised daily exercise. For more information about choosing a nursing home, look at the "Long-Term Care Planning" section under the Resource Locator" tab on the Medicare website.

Publication Review By: Peter V. Rabins, M.D., M.P.H.

Published: 14 Mar 2011

Last Modified: 02 Oct 2014