Finding a nursing home starts with understanding what level of care your loved one actually needs, then narrowing options by quality ratings, cost, and in-person visits. The process can feel overwhelming, but a clear sequence of steps turns it into something manageable. Most families begin with the federal Care Compare tool at Medicare.gov, which lets you search and compare every Medicare-certified nursing home in the country by location, quality scores, and staffing levels.
Confirm That a Nursing Home Is the Right Fit
Before you start comparing facilities, make sure a nursing home is what your loved one needs. A nursing home (also called a skilled nursing facility) provides 24/7 medical care from licensed nurses, including rehabilitation services, wound care, IV therapy, and post-surgical recovery. Licensed practical nurses are on duty around the clock, and a registered nurse is present for at least eight hours every day. Admission typically requires a doctor’s order and often follows a hospital stay or major health event like a stroke, heart attack, or surgery.
If your family member mainly needs help with daily tasks like dressing, bathing, cooking, or managing medications but doesn’t require round-the-clock nursing, assisted living is likely a better and less expensive option. Assisted living is designed for older adults who can’t fully care for themselves at home but don’t need intensive medical support. A nursing home becomes the right choice when someone was recently hospitalized, is recovering from major surgery, has a chronic condition requiring constant nursing, or needs palliative care.
Start With Medicare Care Compare
The single best starting point is Medicare’s Care Compare tool at medicare.gov/care-compare. You can search by zip code or city and instantly see every Medicare-certified nursing home nearby. Each facility gets an overall rating on a one-to-five-star scale, with separate ratings in three categories: health inspections, staffing, and quality of resident care. These ratings come from the CMS Five-Star Quality Rating System, which also now includes data on staff turnover and weekend staffing levels, two factors that directly affect the attention residents receive.
Pay close attention to the health inspection rating. State survey agencies inspect every nursing home at least once a year, and facilities with poor performance or complaints get inspected more often. The inspection results list specific problems (called deficiencies) found during each visit, and these are posted publicly. You can read through them to see whether a facility’s issues are minor paperwork problems or serious care failures. State governments can also impose penalties on nursing homes, and that information may be available on your state’s health department website.
Don’t rely on the star rating alone. A five-star facility might still have recent deficiencies that concern you, and a three-star facility might have improved dramatically in the past year. Read the actual inspection reports.
Build a Short List of Three to Five Facilities
After filtering by location and quality ratings, narrow your options to a handful of realistic candidates. Geography matters more than people expect. Families who visit regularly improve a resident’s quality of life and catch problems early, so choosing a facility within a reasonable driving distance from the primary family caregiver is worth prioritizing even if a slightly higher-rated facility is farther away.
Check whether each facility on your list accepts the payment source you’ll be using. The national average cost for a semi-private room in a nursing home is about $112,000 per year, which works out to roughly $9,400 per month. Medicare covers skilled nursing care only for a limited period after a qualifying hospital stay. Medicaid covers long-term nursing home care for people who meet income and asset requirements, but not every facility accepts Medicaid or has Medicaid beds available. Private long-term care insurance and out-of-pocket payment are the other common options. Confirming payment early saves you from falling in love with a facility you can’t afford or that won’t accept your coverage.
Contact Your State Ombudsman
Every state has a Long-Term Care Ombudsman program, and it’s one of the most underused resources available to families. Ombudsmen investigate and resolve complaints made by or on behalf of nursing home residents. They track complaint histories for individual facilities, represent residents’ interests before government agencies, and can tell you things that inspection reports don’t capture, like patterns of family concerns or how responsive a facility is when problems arise.
You can find your state’s ombudsman through the Administration for Community Living website at acl.gov. Call them before you make a final decision. Ask about the facilities on your short list. They can share general information about complaint trends and help you understand what to look for during your visit.
Visit in Person and Know What to Look For
No amount of online research replaces walking through a facility yourself. Visit at least two or three of your top choices, and try to go at different times of day. A facility that looks calm and well-staffed at 10 a.m. on a Tuesday might tell a different story during evening hours or on weekends.
Medicare publishes a nursing home checklist (available as a PDF on medicare.gov) that covers the key things to observe. The most important ones:
- Odor and cleanliness. The facility should be free from overwhelming unpleasant odors. Occasional smells happen in any nursing home, but a persistent smell of urine or waste suggests understaffing or neglect. Common areas, hallways, and resident rooms should appear clean and well kept.
- Staffing visibility. Nursing homes are required to post information about their nursing staff numbers, including certified nursing assistants. Ask to see it if it isn’t displayed. Notice whether staff seem rushed or whether call lights go unanswered for long stretches.
- Staff-resident interactions. Watch how staff talk to and touch residents. The relationship should appear warm, polite, and respectful. Are residents addressed by name? Do aides knock before entering rooms?
- Resident engagement. Are residents sitting in hallways with nothing to do, or is there evidence of activities and social interaction? Look at the activity calendar and ask residents or family members in common areas what they think.
- Food quality. If possible, visit during a mealtime. Look at what’s being served and whether residents seem to be eating. Ask about menu options and dietary accommodations.
Talk to staff during your visit, but also talk to residents and their family members if you can. The people who live there every day know things the administrator won’t volunteer.
Understand Resident Rights Before Signing
Federal law guarantees a set of rights to every nursing home resident, and knowing them protects your loved one from the start. Residents have the right to access all their medical records and clinical reports promptly on weekdays. They have the right to private visits, private phone calls, and privacy in sending and receiving mail and email. A legal guardian shares these same rights.
The protections around transfer and discharge are especially important to understand. A nursing home cannot force a resident to leave unless it’s necessary for the health or safety of the resident or others, the resident’s health has improved enough that nursing home care is no longer needed, the facility hasn’t been paid for services, or the facility is closing. Except in emergencies, nursing homes must provide 30 days’ written notice before any discharge or transfer, including the reason. Residents have the right to appeal a transfer or discharge to the state. And critically, a nursing home cannot make a resident leave while they are waiting for Medicaid approval.
These protections exist because placement disputes do happen, and families who know the rules are in a much stronger position to advocate for their loved one. Ask the admissions coordinator to walk you through the facility’s discharge policies before you sign any agreement, and keep a copy of everything.
Making the Final Decision
After visiting your top choices, compare them across the factors that matter most for your specific situation: quality ratings and inspection history, proximity to family, acceptance of your payment method, the feel of the facility during your visit, and how staff responded to your questions. No nursing home is perfect, and the “best” one is the facility that matches your loved one’s medical needs, personality, and your family’s ability to stay involved. If you’re torn between two options, a second visit during a different time of day often makes the answer clear.