How to evaluate a nursing home — beyond the star ratings

This article is for informational purposes only and does not constitute medical, legal, or financial advice. Please consult appropriate professionals for guidance specific to your situation.

When you search for nursing homes online, you're going to see star ratings. Those are based on inspections and complaints and metrics. The ratings matter to a point, but they don't tell you what it's actually like to be a person living in a nursing home. Two facilities with the same star rating can be completely different places. You need to look deeper.

The metrics that generate star ratings measure things like: how many health violations have been cited, how many complaints have been filed, how many hours of nursing staff per resident, what infection rates are, medication error rates. These are important metrics. A facility with high infection rates or frequent medication errors is a problem. But these metrics don't tell you what your parent's daily experience is going to be like. You need to find that out in other ways.

Your parent's daily experience in a nursing home is going to depend on whether they feel isolated or connected, whether they have meaningful things to do or just endure boredom, whether staff treats them with dignity or treats them like tasks to complete. These aren't measurable things that show up in star ratings. You have to look for them yourself.

The Isolation Factor

The biggest threat to your parent's quality of life in a nursing home is isolation. Your parent loses their home, their neighbors, their routine. They're surrounded by other elderly people who are often disabled, confused, difficult. Many nursing homes don't actively work to help residents feel connected to life. They manage medical tasks and that's it.

Some nursing homes have actual programming that engages residents. Activities that make sense, not busy work. Visitors come in to play music or do art or teach something. Residents participate in simple group activities. There's a community happening. Some nursing homes have minimal activities. There's a TV in the common area and that's about it. That's a problem because humans need connection and engagement, and without it, people decline faster.

Look for evidence of community. Are residents sitting together or are they isolated in rooms? Is there a bulletin board with activities listed? Is anyone actually participating in activities when you visit? Do staff seem to know residents by name? Are there visitors coming through? Is there a sense that life is happening, or does it feel like people are just waiting?

Some nursing homes help family involvement. They want families there. Some make it complicated. Some facilities are structured in a way that makes it hard for families to be present. If visiting hours are restrictive, if you need to announce yourself repeatedly, if you're treated like an inconvenience when you arrive, that facility is creating isolation. Family is part of what keeps people connected.

Maintaining Relationships

Your parent is going to need you, not for care, because they'll have nursing care, but for relationship. You're the person from their before-nursing-home life. You're someone who knew them as a person, not a patient.

Some families maintain close relationships with parents in nursing homes. They visit regularly. They have conversations about things other than medical updates. They bring outside food sometimes. They do something together. They help friendships between their parent and other residents. They help their parent participate in activities. This takes time and emotional energy, but it makes a difference.

Other families get overwhelmed. The nursing home is depressing. Their parent is declining. The visits are sad and painful. Sometimes they pull back, visiting less, because it hurts too much to go. Their parent becomes isolated. This is understandable but it's hard on your parent. If you can find a way to visit even when it's hard, that matters. Even brief visits matter. A call on the phone matters.

Technology helps for some people. If your parent is cognitively intact, video calls with grandchildren might bring them joy. If your parent has dementia, that won't work, but your presence in person still matters even if they don't remember you.

Including your parent in family events matters when possible. If you're having Thanksgiving, can your parent come home or come to someone's house for the meal? Even if they're medically fragile, even if it's complicated to arrange, it reminds your parent that they're still part of the family. They're not just in a facility. They're connected to something larger than the nursing home.

Some facilities actively support family involvement. They help help outings. They encourage families to visit. They work around medical needs to allow your parent some independence within the facility. Some facilities actively discourage it, making it hard to visit, restricting access to rooms, treating families like problems. A facility that wants family involved is usually a facility that's thinking about quality of life. A facility that discourages family involvement is usually focused only on medical tasks.

Signs Your Parent Is Actually Okay

It's hard to know if your parent is actually okay in a nursing home, especially if they can't communicate clearly. You're looking for signs that they're not just surviving but actually have some level of acceptable quality of life.

Some signs are obvious. Your parent says they're okay. They're engaged in activities. They've made friends with other residents. They have good days more than bad days. They're eating. They're not losing weight. They're clean and cared for. They seem settled.

Some signs are subtle. Your parent is calm more than agitated. Your parent seems to recognize you when you visit. Your parent has moments of being engaged, even if memory is affected. Your parent laughs sometimes. Your parent isn't in obvious pain. Your parent's medical condition is stable or improving.

Some signs require you to notice what's not happening. Your parent is not covered in bedsores. Your parent is not always sedated. Your parent is not fighting with staff regularly. Your parent is not crying constantly. Your parent has clean clothes. Your parent has been showered. Your parent's medications seem to be being given as prescribed.

Talking to your parent helps if they can talk. "Are you okay here?" "Is the food okay?" "Are people treating you okay?" "Do you feel safe?" If your parent can answer, listen to the answers. Some people will complain about everything even if they're fine. Some people will say they're fine when they're not. Try to figure out which is which based on what you actually observe.

Talking to other residents helps. Other residents will tell you the truth. Ask them what it's like. Ask them about staff. Ask them about food and activities and whether they feel safe. Take their answers seriously.

Talking to staff and noticing how they interact with your parent helps. Do they seem to know your parent? Do they talk to your parent like a person? Do they seem harried and resentful or relatively calm? Staff burnout makes everything worse. Staff who like their job usually provide better care.

You're not looking for perfect. You're looking for good enough. Good enough means your parent is safe, their medical needs are met, they're not in obvious distress, and there's some element of human dignity and connection, however small. If you can find that, your parent can be okay in a nursing home. If you can't, you need to keep looking or consider other options.

How To Help Your Elders provides educational content for family caregivers. This is not a substitute for professional medical, legal, or financial advice. Every family situation is different — what works for one may not work for another.