Monitoring care quality after the move — staying involved

Reviewed by the How To Help Your Elders Team

Ongoing family involvement is one of the strongest predictors of good care in a nursing facility. CMS inspection data is publicly available for every Medicare-certified nursing home, and families who visit consistently, ask specific questions, and document concerns catch problems earlier and get better outcomes for their parents.

The Biggest Risk Is Drifting Away After the Crisis Passes

Three months in, the crisis mode is over. Your parent has adjusted to some degree. The emergency that prompted placement has been managed. Life settles into a rhythm. You visit on weekends. You get occasional updates from the facility. Things seem fine. Then you miss a week of visits. Then you miss two weeks. The urgency is gone. The demands of your own life reassert themselves. Months go by with minimal contact. Your parent has adapted and seems reasonably content.

This is where quality of care problems often develop. Not because of malice, but because of human nature. When families are present and attentive, facilities tend to function better. Staff members who know a family member will see their parent today are more likely to make sure your parent's appearance is neat, their medications are on time, any problems are attended to. When families are absent, the attention can drift. Your parent becomes one of thirty residents. Their individual needs matter less because there's no one watching to make sure they're addressed.

This doesn't mean you have to visit every day. Reasonable ongoing involvement can be much less frequent than the early involvement phase. But it needs to be consistent and present. Your parent is in a facility for months, possibly years. They need to know you're still there, still advocating, still paying attention. The facility needs to know they're accountable.

Evaluating the Quality of Care Your Parent Receives

Nursing home quality varies enormously. According to CMS data, roughly 20 percent of nursing homes receive the lowest one- or two-star ratings on Medicare's Care Compare tool, while only about 30 percent achieve four or five stars. The difference between a good facility and a bad one isn't always visible to families who don't know what to look for. A facility can look clean and run smoothly and still be providing inadequate care. A facility can look a little chaotic and still be excellent with individual residents.

Infection rates are one real indicator of care quality. Ask your facility directly: what's your infection rate? What's your urinary tract infection rate? What's your rate of methicillin-resistant Staphylococcus aureus, commonly known as MRSA? Good facilities know these numbers and can share them with families. They also compare their rates to other facilities. If your facility's infection rate is significantly higher than state averages, that's a problem. According to the CDC, approximately one to three million infections occur in nursing homes every year, and many are preventable through proper hygiene, wound care, and catheter management.

Family complaints and regulatory violations are another measure. Your state's Department of Health has inspection records for nursing facilities available online, and CMS publishes this data through its Care Compare website at medicare.gov/care-compare. Look at recent inspections. What violations were cited? Most facilities have some violations, but look for patterns. Are there repeated violations around the same issues? Are there any violations around abuse, neglect, or quality of care? Are there violations that suggest poor staffing or inadequate training? Some violations are minor. Some are serious. Learning to distinguish between them matters.

Staff expertise and turnover also tell you something important. Who is the medical director? What are their qualifications? Who is the nursing supervisor? How long have they worked there? If there's very high turnover in key positions, that's a concern. CMS reports that nursing homes with higher registered nurse staffing levels consistently show better quality outcomes. Ask about training frequency and whether staff are trained specifically on things your parent needs, like dementia care or wound care or management of specific medical conditions.

Red Flags That Demand Immediate Attention

Pressure sores, also called bedsores or decubitus ulcers, are a red flag. A pressure sore means your parent has been left in one position too long or their skin hasn't been properly protected. Good facilities prevent pressure sores through positioning changes, special mattresses, and skin care. According to AARP, pressure ulcers affect up to 28 percent of nursing home residents, and the vast majority are preventable with proper care. A new pressure sore developing in a facility is a sign of neglect.

Injuries from falls are concerning. Occasional falls happen, but if your parent has had multiple falls, or if a fall resulted in serious injury, the facility should have been monitoring your parent more closely or taking precautions to prevent falls. Ask what happened after each fall. What changes did the facility make to prevent the next one? If the answer is "nothing specific," that's a problem.

Medication errors are serious. Did your parent miss doses of medication? Did they receive someone else's medication? Did they receive an incorrect dose? These should not happen. If they do, it suggests poor pharmacy processes or inadequate nursing oversight. One medication error is a problem. Multiple suggest systemic issues.

Poor hygiene is visible and concerning. Does your parent look clean? Are their clothes clean? Do they smell of urine? Do their nails look cared for? Do they have bad breath that suggests dental care is lacking? These things might seem minor but they indicate whether the facility is attending to your parent's basic needs and dignity. Someone isn't making sure your parent showers. Someone isn't brushing your parent's teeth. Someone isn't changing clothes when they're soiled. This is not accidental. It's a choice about whether to do the work.

Weight loss without explanation is also concerning. Is your parent eating? Are they getting enough nutrition? Is food being adapted if your parent has swallowing difficulties? Unexplained weight loss can indicate your parent isn't eating enough or isn't able to eat properly. It can also indicate they're developing a medical condition. Either way, it should prompt investigation.

What to Monitor on an Ongoing Basis

Beyond those specific red flags, pay attention to your parent's overall health trajectory and emotional state. Is your parent declining more rapidly than you'd expect? Is your parent increasingly confused or withdrawn? Is your parent in pain? Is your parent developing new medical problems frequently?

Some decline is expected. Your parent is aging. But rapid decline or decline beyond what makes sense for their condition can indicate something is wrong. Ask questions. What's changed? Is the facility aware of the decline? What are they doing about it?

Pain management is important. Your parent might minimize pain to avoid being a burden, or they might not communicate pain clearly if they have cognitive impairment. Watch for signs of pain: grimacing, guarding a particular area, agitation, behavior changes. Ask your parent directly about pain. Ask the staff whether they're monitoring for pain. Uncontrolled pain isn't just cruel. It interferes with recovery, with nutrition, with sleep, with everything.

Monitor dignity and autonomy. Is your parent being treated with respect? Are they being included in decisions about their care? Are they able to maintain their own preferences and personality? Some facilities treat residents like objects to be managed rather than people with preferences. Your parent might wear clothes chosen by staff rather than clothes they prefer. Your parent might eat at times set by the facility rather than when they're hungry. Some of this is necessary for facility operations, but facilities can do this while still preserving dignity. If your parent feels like they have no say in anything about their own life, that's a problem.

Pay attention to whether your parent is socially isolated or engaged. Is your parent participating in activities? Visiting with other residents? Getting outside? Seeing visitors? Isolation contributes to depression and decline. A good facility works to keep residents engaged and connected, even when that requires effort.

Frequently Asked Questions

How often should I visit my parent in a nursing home?
There is no universal right answer, but consistency matters more than frequency. A weekly visit creates a predictable pattern that keeps staff attentive and gives your parent something to look forward to. If weekly isn't possible, biweekly or even monthly visits work if you supplement with phone calls and stay in regular contact with the care team. Vary the times and days you visit so you see different shifts and different routines.

Where can I find inspection reports for my parent's facility?
CMS publishes inspection results, staffing data, and quality measures for every Medicare-certified nursing home at medicare.gov/care-compare. Your state's Department of Health also maintains inspection records, often with more detail than the federal database. These records show specific violations cited during inspections, the severity of each violation, and whether the facility corrected the problem.

What should I do if I find a bedsore on my parent?
Report it to the nursing supervisor immediately and ask for a written explanation of how it developed and what the treatment plan is. A new pressure sore in a facility is a serious care concern. Document it with photographs if possible. If the facility does not respond adequately, contact your state's long-term care ombudsman or file a complaint with the state Department of Health. Pressure sores are largely preventable with proper turning schedules and skin care, and their presence often indicates inadequate attention to your parent's positioning needs.

Can I install a camera in my parent's room?
Laws about cameras in nursing home rooms vary by state. Some states explicitly allow it with the resident's consent, some require consent from any roommate as well, and some prohibit it. Check your state's specific laws before installing any recording device. If cameras are permitted, let the facility know you've installed one, as transparency tends to improve care rather than create conflict.

What is a long-term care ombudsman and how can they help?
A long-term care ombudsman is a federally mandated advocate for residents of nursing homes and assisted living facilities. They investigate complaints, mediate disputes between families and facilities, and help families understand their rights. Their services are free. You can find your local ombudsman through the Eldercare Locator at 1-800-677-1116 or at eldercare.acl.gov. The ombudsman can be a powerful ally when your concerns aren't being addressed through normal facility channels.

How do I know if my parent should be moved to a different facility?
Consider a move if you see a pattern of unresolved problems: recurring infections, repeated falls without preventive action, medication errors, persistent hygiene issues, or documented violations that the facility hasn't corrected. A single bad day does not mean the facility is bad, but a pattern of issues across multiple visits and multiple conversations suggests the facility cannot or will not provide the care your parent needs. Consult your parent's doctor and the state ombudsman before initiating a transfer.