How to Choose a Nursing Home

A couple receives a dose of the coronavirus vaccine at a nursing home in Tel Mond, Israel, on Jan. 6, 2022. Amir Levy/Getty Images

Your loved one has reached the point where they can’t care for themselves. In-home care isn’t enough, and there’s now a safety factor. It’s time to choose a skilled nursing facility or nursing home.

There are many options available. Nursing homes have become big business. Nearly 2.3 percent of seniors live in them. Although that figure seems low, it’s significant when it includes your loved one. So, where do you start when searching for the right home? And how do you pay for it?

Regulations Regarding Nursing Homes

All nursing homes that receive Medicare or Medicaid funding are subject to federal and state regulations. They must have a visiting doctor assigned to the facility, skilled nurses, and adequate staff.

They also must develop a comprehensive wellness plan for each resident. It starts with conducting a comprehensive and accurate assessment of the resident’s functional capacity. The family must be part of this assessment and plan.

The plan must be followed thoroughly. The basics, including nutritional needs, must be met. The goal is to promote the residents’ quality of life.

These are some of the requirements that a nursing home must meet, but there are other clues that you’re in a good facility.

Factors That Distinguish a Good Nursing Home From a Bad One

How does it smell? When you walk into the nursing home, do you smell urine, or is there a clean scent? A nursing home that’s not on top of hygiene for the residents may smell like urine. There also may be soiled rugs and furniture that hasn’t been thoroughly cleaned.

Are the bathrooms and floors clean? Look around and if you notice dirt, that can also indicate the potential for sickness among the residents.

There should be an abundance of staffing. You'll want to know the staff-to-resident ratio. Except for California, states have a minimum ratio requirement for staff-to-resident care. Each state is different.

However, the ideal ratio of staff to residents in the United States is one staff member for every six to eight residents. But that’s not what usually happens. The reality is that in 2023, the minimum requirement for 121 residents was 1:40 for RN/LPN in a 24-hour coverage. For a certified nurse aid (CAN), the ratio is 1:20 for CNAs to residents.

One of the first questions you should ask is about the staff-to-resident ratio.

Make it a point to have a meal at the prospective nursing home. How does it taste? Is it balanced? Look around at the other residents. Are they being assisted in eating if they need it?

You also want to see what activities that have for the residents. Do they keep them engaged? You might want to look elsewhere if you see people slumped over in chairs around the place.

What’s the Incidence of Infectious Diseases?

Infectious diseases run rampant through nursing homes. The 16,000 nursing homes in the United States have an average of two million infections yearly. Considering over 1.5 million seniors are living in nursing homes, this is an alarming number.

Infections lead to rehospitalization and or death. It’s essential to know how the facility you’re touring handles sickness. Ask about the latest outbreak or how many outbreaks the facility commonly has yearly.

Paying for Skilled Nursing Home Care

It’s hard enough paying for in-home care, but nursing home care can bankrupt a spouse. There are ways to plan to cover the cost. Here are four ways to cover nursing home care.

Private Pay Comes Out-of-Pocket

The wealthy might be able to afford nursing home care out-of-pocket. In the United States, a shared room costs an average of $7,908 monthly, while a private room costs $9,034.

If the prospective patient is married, this could be a hardship. Many turn to a reverse mortgage or sell their largest asset if they are single.

Long-Term Care Insurance

Long-term insurance covers long-term services for care, such as personal and custodial. They will cover this in:

• in-home care
• facility care
• community organizational care

You can select a range of care options. This form of insurance appeared in the 1980s and 1990s. It was very inexpensive and sold well, but a multitude of claims has driven the price upward.

Premiums vary according to gender and age. But, the average 60-year-old male will pay $1,200 annually. Meanwhile, a 60-year-old woman will pay roughly $1,960 per year. The disparity is that women tend to live longer.

If you purchase a couples policy, you could save 15 percent.

Medicaid Pays for Long-Term Care

Medicare only covers the first 100 days in a nursing home. It may be enough time for your loved one to recover and move home.

But once the 100 days are over, self-pay kicks in. If you don’t have the funds to pay the nursing home bill, Medicaid is an option. Your loved one must basically be impoverished to qualify for Medicaid.

They cannot give their assets away within five years of applying for Medicaid, so you can’t save their house. But if a spouse lives in the house, he or she is allowed to keep it while alive. Upon their death, the house is sold, and the proceeds reimburse the government for the nursing home payments.

Preparing for a Nursing Home

Plan so you’re not rushing to find a nursing home at the last minute. You'll want to choose one that meets your loved one’s needs and is safe.

Purchasing a long-term insurance policy is a sound way to pay for nursing care. But remember, the percentage of seniors who wind up in long-term care is only 2.3 percent.

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