When to move them to a different facility — recognizing poor care
Reviewed by the How To Help Your Elders Team
Sometimes the facility is the problem. Your parent is losing weight, developing pressure sores, or showing signs of rough treatment, and nothing improves no matter how many times you escalate. This guide helps you distinguish between the inherent discomforts of institutional care and genuine failures in quality, and explains how your visits and involvement shape what happens.
If your parent's care needs aren't being met after repeated attempts to fix the problems, it's time to move them
Sometimes the facility your parent is in is not good. Not just "still adjusting" or "settling in," but genuinely failing to provide adequate care. Your parent is losing weight. They're developing pressure sores. They're not getting medications as prescribed. They're being treated roughly by staff. You notice bruises you can't explain. Your parent is withdrawn and scared. No matter what you say, things aren't improving. You've talked to the facility director. You've escalated concerns. Nothing changes. The facility is the problem, and your parent needs to move.
Moving your parent is disruptive. Another transition. Another loss. Another place to adjust to. Your parent might be reluctant. Moving costs money, time, and emotional energy. There's never a good time to move. But sometimes moving is the right choice. The facility doesn't have to be abusive for moving to be necessary. It just has to be failing your parent. CMS inspection data shows that roughly 1 in 4 nursing homes has been cited for deficiencies that caused actual harm or immediate jeopardy to residents, and those are only the problems that inspectors catch during scheduled surveys.
Before you move someone, be clear about what the actual problems are and whether moving will fix them. Some problems are specific to this facility. Some problems are inherent to any facility because of your parent's condition or limitations. Moving won't fix the second kind. But if your parent is actually being neglected or their medical needs aren't being met, another facility might be better.
What Nursing Home Life Actually Looks Like
Understanding what nursing home life is actually like helps you assess whether the problems you're seeing are serious or whether they're part of being in a facility. Nursing homes are institutions. They run on schedules. Your parent eats when the kitchen puts out meals, not when they want to eat. Your parent showers on the schedule the staff sets. Privacy is limited. Your parent shares a room with a roommate. Staff come in at all hours. Noise is constant. The lights and temperature are controlled by the facility.
This is genuinely uncomfortable and dehumanizing in ways that home never is. Your parent has little control over basic decisions about their own life. This creates a kind of institutional depression that's hard to address. Some people adapt. Some people never do. But this isn't abuse. It's the nature of institutional care.
Autonomy is limited in other ways too. Your parent might want to sleep until eight in the morning, but breakfast is at seven. Your parent might want to wear their favorite shirt, but it's in the laundry. Your parent might want to spend time alone, but activities are encouraged for everyone. Some facilities are more flexible about this than others, but no facility gives residents the complete autonomy they had at home.
Some of this is because of staffing. According to CMS data, average staffing levels in U.S. nursing homes hover around 3.6 total nursing hours per resident per day, which includes registered nurses, licensed practical nurses, and certified nursing assistants. Many facilities fall below that average. There aren't enough workers to accommodate individual schedules and preferences, aren't enough people to check on residents individually or provide one-on-one attention. The staff is doing their best with limited resources. But the result is a system where residents are managed more than they're cared for.
Sometimes the rules are also arbitrary. Facilities have policies that don't have good reasons beyond "that's how we do it." Visiting hours. The amount of personal possessions your parent can have. Rules that protect the facility more than they protect the residents. A flexible facility works with families to make exceptions. A rigid facility enforces rules inflexibly. Both exist.
What Good Care Looks Like
A good facility tries to preserve your parent's identity and individuality despite the institutional structure. They ask about your parent's preferences. They use your parent's name. They allow personal items from home. They encourage your parent to participate in activities they actually enjoy, not just whatever is being offered. They treat your parent like a person with a life and history, not just a task to complete.
Staff tone matters enormously. Respectful staff speak to residents as adults. Dismissive staff use baby talk, talk about residents like they're not there, make decisions without asking the resident's input. Rough staff grab and move people without explanation. Gentle staff explain what they're doing and ask permission. The difference is visible from the moment you walk in.
Your parent's room and appearance tell you a lot. Is the room dignified or does it look like a hospital? Does your parent have personal items that remind them of who they are, like photos, books, favorite clothes, a comfortable chair? Or is the room bare and institutional? Is your parent clean and well-groomed, or do they look neglected? These things communicate whether the staff views your parent as a person worth honoring or as a task to complete.
Your role as a family member changes in a facility. You can't manage everything. But you can support your parent's autonomy where possible, encourage them to make choices about their own care, advocate for their preferences, bring items from home that make the room feel personal, and treat your parent with respect that reinforces their identity beyond the facility walls.
Sometimes this creates friction with staff. Staff has systems and schedules. Your parent's preferences don't fit those systems. The facility wants to give medication at nine in the morning and your parent wants it after breakfast. The facility wants to shower your parent on Tuesday and your parent wants Wednesday. These seem like small things. But when your parent has no control over anything, small things matter enormously. A good facility finds a way to accommodate. An inflexible facility insists on their schedule. Inflexibility isn't abuse. But it creates suffering and loss of dignity. If your parent can't tolerate it, another facility might be better.
How Your Visits Shape the Care
How you visit and interact with your parent and staff shapes what happens. If you visit and get angry with staff, blame them for your parent's suffering, and criticize the facility, it poisons the relationship. Staff become defensive and resentful. The care doesn't improve. If you visit and are kind to staff, treat them with respect, and thank them for their effort, they become more attentive to your parent. This isn't about accepting poor care to be nice. It's about creating an environment where staff are willing to go the extra mile.
When you visit, don't take over. Don't do things for your parent that they can do for themselves. Don't correct your parent in front of staff. Don't intervene in interactions unless your parent is actually being harmed. Step back and let your parent maintain their dignity and agency. Be present without controlling.
Don't undermine the facility's work either. If your parent refuses to participate in therapy and you side with your parent, the facility gives up on recovery. If your parent wants to stay in bed all day and you validate that as understandable, the staff stops encouraging movement and participation. Sometimes your parent needs to hear from you that they can do this, that recovery is hard but worth it, that you believe in them. Sometimes your parent needs to hear that you understand it's hard and it's okay to have difficult days.
Be available but not omnipresent. If your parent can reach you by phone, they may call every time something is uncomfortable. If that's how your parent copes, that's okay. But recognize that your constant availability can affect whether your parent develops their own way of managing within the facility. Some families set boundaries around call schedules. Some are always available. It depends on your parent's needs and your capacity.
Ultimately, whether you stay or move depends on whether the facility is meeting your parent's genuine needs, treating them with dignity, and providing adequate medical care. If those things are happening, the institutional nature of the place is simply the trade-off you make for safety and supervision. If those things aren't happening, moving is the right call.
Frequently Asked Questions
How do I check a facility's inspection history?
Medicare's Care Compare website (medicare.gov/care-compare) publishes nursing home inspection results, staffing data, and quality measures for every Medicare-certified facility. Look at the most recent standard survey, any complaint investigations, and whether the facility has been cited for harm-level deficiencies. Your state's long-term care ombudsman office can also provide information about complaint patterns.
What should I do if I suspect abuse or neglect?
Document everything: take photos of injuries, write down dates and details of incidents, and keep notes on conversations with staff. Report your concerns to the facility administrator in writing, file a complaint with your state's long-term care ombudsman, and contact Adult Protective Services. If you believe your parent is in immediate danger, call 911.
Can a facility prevent me from moving my parent?
No. Residents have the right to transfer or discharge at any time. The facility may require notice (often 30 days) and will need to coordinate medical records and medication transfers, but they cannot hold your parent against their will. If a facility tries to obstruct a transfer, contact your state ombudsman.
How do I find a better facility?
Start with Care Compare for inspection data, then visit in person at different times of day, including evenings and weekends. Talk to families of current residents. Ask your parent's doctor for recommendations. Contact your local Area Agency on Aging for guidance. When touring, pay attention to staff interactions with residents, cleanliness, smell, and whether residents appear engaged or just warehoused.
Will moving my parent to a new facility set them back?
Any transition is difficult, especially for someone with cognitive impairment. There will be an adjustment period. But if the current facility is providing poor care, the harm of staying outweighs the disruption of moving. Choose the new facility carefully, visit often during the transition, and bring familiar items from their room to help with the adjustment.
What if I can't afford a better facility?
If your parent is on Medicaid, your state's Medicaid program will cover the transfer to another Medicaid-accepting facility. If your parent is on private pay, the cost difference between facilities may be significant. Contact your state ombudsman and Area Agency on Aging to understand your options, as some states have programs that help families in this situation.