How do I choose a nursing home?

The four steps Medicare lays out

Step one is research. Find and compare the homes in your area, ask people you trust whether they have personal experience with a local home and would recommend it, and ask your own doctor whether they provide care at any nearby homes so you can keep them. If you are in a hospital, ask your social worker about discharge planning as early as possible, because the staff there can help match you with a home and arrange the transfer.

Step two is comparing quality, which Medicare describes as a set of specific things rather than a general impression. Step three is the visit, and Medicare is specific that a visit is how you judge the quality of care and of daily life, and that a family member or friend can visit if you cannot. Step four is the choice itself, weighing everything with the people who understand your health and personal needs.

Compare quality with three measures

When Medicare says to compare quality, it points to three criteria: health inspection results, nursing home staffing, and quality measures. Those three are reported together on Care Compare, so it is worth opening the tool and reading them for each home on your list rather than judging from a brochure.

Inspection results record what a state survey found, including any deficiencies. Staffing shows how many people are available to give care, and homes are required to post the number of nursing staff, including certified nursing assistants, and to show it on request. Quality measures track how residents fare over time. A home can look fine in a lobby and still carry a serious inspection finding, which is why the three are meant to be read next to each other.

The 12-point checklist

These twelve checks come from the nursing home checklist Medicare publishes. It is written to be filled in during a visit, with a yes, no and a notes column for each line, and Medicare recommends a new copy for every home you tour so the notes do not blur together.

1. 1Confirm the home is Medicare and Medicaid certified. Certified means the home passed an inspection run by a state government agency, and Medicare and Medicaid only cover care from certified homes. Ask whether the home has recently lost certification, or is about to.
2. 2Confirm the home and its administrator are licensed in your state. A state or local license means the facility has met that state standards. The administrator holds a license too, and it is fair to ask about either one.
3. 3Read the health inspection results. Inspection results are one of the three things Medicare tells you to compare. They record what a state survey found, including any deficiencies and how serious they were.
4. 4Look at the staffing numbers. Medicare tells you to compare staffing. Nursing homes are required to post information about the number of nursing staff, including certified nursing assistants, and to show it to you if you ask. Ask whether a registered nurse is on site and how often.
5. 5Review the quality measures. Quality measures are the third comparison Medicare names. They track things like how residents fare over time, and they are reported next to the inspection and staffing data so you can read them together.
6. 6Confirm a bed is actually available. A home you like with no open bed is not yet an option. If you are in a hospital, the discharge planner can tell you which homes have a bed and can arrange the transfer when you are ready to leave.
7. 7Ask what specialized care the home offers. Ask about a special care unit for a resident with dementia, or ventilator care, if either might be needed. Every nursing home is required to provide rehabilitation services, so therapy is available everywhere.
8. 8Ask for the written list of services, charges and fees. Medicare and Medicaid certified homes must tell you in writing what they provide and what it costs before you move in. Get the fee schedule so you can see which services are included in the monthly rate and which cost extra, such as beauty shop services.
9. 9Walk the living spaces and watch the residents. Look for overwhelming odors, and check whether the home appears clean and well kept. Watch the residents: are they clean, well groomed and dressed for the season and time of day? Check the lighting, the temperature, the noise level and whether smoking is restricted.
10. 10Check the food and the mealtimes. Ask whether residents have a choice at each meal, whether the home can handle a special diet such as low salt or no added sugar, whether snacks are available on request, and whether staff help residents eat and drink when help is needed.
11. 11Check safety and physical access. Look for clearly marked exits, smoke detectors and sprinklers, doorways and common areas designed for wheelchairs, and handrails and grab bars placed where they are needed in hallways and bathrooms.
12. 12Check daily life and how much control residents keep. Ask whether residents choose their activities, whether there are outdoor areas with staff to help people get outside, whether residents pick their roommates, and whether a resident chooses when to get up, go to sleep or bathe.

Get the fee schedule before you decide

Medicare and Medicaid certified homes must tell you in writing about their services, charges and fees before you move in. Ask for the fee schedule and read it as a second checklist: which services are included in the monthly rate, and which cost extra. It is also fair to ask about charges outside the rate, such as beauty shop services, so the first invoice is not the first time you see them.

For scale, the 2025 national medians this site tracks put a semi-private nursing home room at about $9,581 a month, and a private room higher. The quoted monthly rate is a starting point, not a final number, because therapies, medications and extra services sit on top of it. Walk through the nursing home cost breakdown alongside the fee schedule, and use the care cost calculator to see what a rate means where you live.

Beds, and leaving if it is not right

Availability decides the pace. If more than one home you like has a bed open, compare the full picture before deciding, and talk it through with the people who know your care needs. If you are in a hospital and decline a home that has a bed, the discharge planner or your doctor may help you find a better fit or arrange short-term care until a bed opens where you want. One caution from Medicare: if you stay in the hospital while you wait, you may owe the full amount for the extra days.

After the move, the decision is not final. If a home turns out not to be the right fit, you can move to another facility that has an available bed. You may have to give the current home notice ahead of time, so ask about the rules for leaving, because not following them can mean extra fees. Moving in or out of a nursing home is also one of the times you can change your Medicare drug plan.

Where these rules come from

The four steps, the three quality criteria and the visit guidance were read from the Medicare.gov page on choosing a nursing home. The twelve checks were read from the nursing home checklist Medicare publishes at Medicare.gov, including the certification, licensing, staffing, fee schedule, living space, food, safety and daily life questions. The Medicare coverage limits, including the point that Medicare does not cover custodial care when it is the only care needed, were confirmed on Medicare.gov. Care costs are the 2025 national medians published by the cost survey named above, attributed next to each figure. Certifications and licenses are set by state agencies, so verify them against your own state. This is not medical, legal or financial advice for an individual decision.