Connecticut Long Term Care Ombudsman Program

Choosing a Nursing Home

Consumer’s Guide to Choosing a Nursing Home (PDF)

Placing a loved one in a nursing home is very hard. When it must happen, residents and families need clear, honest information. This page can help you explore options, understand available information, ask better questions, and make a more informed choice.

First, Explore Alternatives

Try to plan for long-term care needs before there is a crisis. Talk with your loved one and close family or friends about care wishes. Planning early can make later decisions easier.

Before you look for a nursing home:

  • Make sure your loved one’s health has been carefully checked.
  • Review the support they already have at home.
  • Ask doctors if treatment could improve their condition.
  • Ask whether they can stay at home with more help.

Many people can remain at home if they receive the right support. Most people want to stay in their own home, so it is important to look at other options besides a nursing home.

Possible options may include:

  • Home care
  • Adult day care
  • Assisted living
  • Other long-term services and supports in the community

You can learn more about available services from:

If nursing home care is needed, it may also help to consider whether the person needs short-stay rehabilitation or long-term care. These are different needs, and the right questions may be different depending on the situation.

Do Your Homework

Before you visit any homes, do some research. No single website, rating, score, or report can tell the whole story. The goal is to gather enough information to understand what questions to ask when you visit or speak with the facility.

Think about these points when you compare homes:

  • Quality of care
  • Quality of daily life for residents
  • Whether there is a bed open
  • Whether the home offers the services your loved one needs
  • Cost and how care will be paid for
  • Location and how easy it is for family and friends to visit
  • Staffing levels and staffing patterns
  • Inspection and complaint history
  • Resident and family satisfaction
  • Ownership and management information

Ask for opinions from:

  • The person who may live in the nursing home
  • Current nursing home residents
  • Residents’ family members
  • Citizen advocacy groups
  • Your loved one’s doctor
  • Hospital discharge planners
  • Clergy or faith leaders
  • The Long-Term Care Ombudsman Program

Use Public Information and Data Tools

Public information can help residents and families compare nursing homes, notice patterns, and prepare better questions. These tools should be used along with visits to the home, conversations with residents and families, inspection reports, satisfaction scores, and help from the Long-Term Care Ombudsman Program.

Two helpful places to start are Medicare Care Compare and other public data tools, such as PBJ320.

  • Medicare Care Compare is a federal website that lets you search for nursing homes and review information about inspections, staffing, quality measures, ownership, and basic facility details.
  • PBJ320 is a public tool that allows users to explore nursing home staffing data over time, including staffing by position, ownership information, and state-level trends.

These tools do not tell you which nursing home to choose. Instead, they can help you better understand one part of the larger picture and decide what questions to ask.

What You Can Compare

When using Care Compare, PBJ320, or similar public tools, look for information that helps you understand the larger picture of a nursing home.

You may be able to compare:

  • Basic information about the home
  • Ownership type and whether the home is part of a larger chain
  • Inspection results
  • Complaint history
  • Staffing levels
  • Staffing by position, such as nurse aides, licensed nurses, and registered nurses
  • Quality measures
  • State and national averages
  • Trends over time

Facility Overview and Ownership

Start by looking at basic information about the home. This may include:

  • Ownership type, such as for-profit, non-profit, or government-owned
  • Whether the home accepts Medicare, Medicaid, or both
  • The size of the facility, including the number of certified beds
  • Whether the home is part of a larger chain or ownership group

Ownership information does not tell the whole story by itself, but it may help you understand who operates the home and whether there have been changes in management or ownership. If ownership has changed, you may want to ask how that change has affected staffing, care, leadership, and daily life for residents.

Complaint and Inspection Information

Complaint and inspection information can help you understand concerns that have been reported or identified in a nursing home.

On Care Compare, you can review inspection results and complaint-related information. You can also ask for inspection reports from the state survey agency, the facility itself, or the Long-Term Care Ombudsman Program.

When reviewing this information, consider asking:

  • What problems were found?
  • How serious were the problems?
  • Were the problems corrected?
  • Do the same concerns appear more than once?
  • What does the facility say it has done to improve?

Staffing Information

Staffing is one important part of quality care. Public staffing information can help you see how a nursing home is staffed compared with other homes, state averages, or national averages.

Care Compare provides staffing information for each nursing home. PBJ320 and similar tools may allow you to look at staffing in more detail over time, including total staffing and staffing by position.

When reviewing staffing information, consider:

  • How many hours of nursing care residents receive each day
  • Certified Nursing Assistant, or CNA, staffing, because CNAs provide much of the hands-on care
  • Registered Nurse, or RN, staffing, because RN involvement is important for clinical oversight and care quality
  • Whether staffing appears steady or changes over time
  • How the home compares with other homes in the area
  • Whether staffing patterns raise questions you want to ask during a visit

Staffing numbers can help you prepare questions, but they should not replace what you see and hear during a visit. When you visit, ask staff, residents, and families how staffing feels during the day, evening, night, weekends, and holidays.

Questions to ask may include:

  • How many staff are usually working on each shift?
  • Are residents usually cared for by the same staff?
  • Does the home use temporary agency staff? If so, how often?
  • How quickly are call lights answered?
  • How does the home make sure residents get help with meals, toileting, bathing, and getting out of bed?
  • What is the facility doing to recruit and keep staff?

Cautions:

  • Staffing data is only one part of understanding care.
  • Reported staffing hours may include some administrative time, not only hands-on care.
  • Staffing numbers are reported by the facility and may not tell you everything about daily life in the home.

Quality Measures

Care Compare also shows quality measures for nursing homes. These measures are based on resident assessments and are reported for both long-stay and short-stay residents.

Quality measures may help you compare homes, but they are not a complete rating system. A nursing home may do well in one area and have concerns in another.

Use quality measures along with:

  • Visits to the home
  • Conversations with residents and families
  • Inspection reports
  • Complaint information
  • Staffing information
  • CoreQ resident and family satisfaction scores, when available
  • Information from the Long-Term Care Ombudsman Program

Use the Information to Ask Better Questions

Public information is most helpful when it leads to better questions. Before choosing a nursing home, write down what you notice and bring those questions with you when you visit or speak with facility leadership.

For example, you may want to ask:

  • I noticed your staffing changes over time. Can you explain why?
  • How does your current staffing compare with what is shown in public data?
  • What are you doing to recruit and keep staff?
  • I noticed past inspection concerns. What has changed since then?
  • How do residents and families raise concerns?
  • Is there a resident council or family council I can speak with?

Remember: numbers and reports are useful, but they are only part of the decision. The resident’s needs, preferences, rights, daily life, and personal experience should remain at the center of the choice.

Use CoreQ Resident and Family Satisfaction Scores

Use more than one source of information when you choose a home. One helpful tool in Connecticut is the CoreQ Resident and Family Satisfaction Survey.

The CoreQ Survey:

  • Gives ratings from residents and family members
  • Covers Medicaid-certified nursing homes in Connecticut
  • Shows how people feel about care, staff, and the building

You can use CoreQ scores to:

  • Compare nursing homes
  • Set your expectations
  • Decide what questions to ask
  • Raise concerns or suggest improvements

For more details and results, visit the CoreQ Resident and Family Satisfaction Survey page.

Experts to Consult

The Prospective Resident

The most important expert is the person who will live in the nursing home. Their wishes, needs, routines, and preferences should guide the decision.

Ask your loved one:

  • Do you want to live near a certain family member or friend?
  • Do you want to stay in your hometown?
  • Do you prefer a large or small facility?
  • What daily routines are most important to you?
  • What would help this feel more like home?

Long-Term Care Ombudsman and Citizen Advocates

A Long-Term Care Ombudsman Program or a citizen advocacy group can help you put together the information you find. They can help you compare homes, understand your options, and think through questions to ask.

An ombudsman:

  • Is funded by the state or county
  • Works for people in nursing homes, board and care homes, and assisted living
  • Knows many local homes, staff, and residents

Ombudsmen:

  • Teach residents, families, and providers about residents’ rights and good care
  • Look into complaints and speak up for residents’ rights and quality care
  • Share information with the public about nursing homes and long-term care issues

The ombudsman can help you find state inspection reports, understand quality measures, review public information, and think through what questions to ask when comparing nursing homes.

Cost Information

Most nursing homes take Medicare, Medicaid, or both. These programs help pay for some or all of the cost of care.

  • Medicare usually pays for short-term rehabilitation after a hospital stay and for hospice care.
  • Medicaid pays for longer-term nursing home care for people who qualify by income and assets.

Many people start by paying with their own money. Because care is very expensive, most people cannot pay on their own forever. Many residents later apply for Medicaid to pay for their care.

If you are not sure the resident can pay privately for a long time, choose a home that accepts Medicaid. Ask about your state’s Medicaid rules.

Spouses can often keep some assets and income even when their partner is on Medicaid. To learn more about rights for residents on Medicaid, contact the Long-Term Care Ombudsman Program or a local consumer advocacy group.

Measures for Long-Stay Residents

Long-stay residents live in the nursing home for a long time. Quality measures for long-stay residents may include flu and pneumonia shots, changes in daily living needs, time spent in bed or in a chair, use of restraints, incontinence, urinary tract infections, pressure sores, mood, pain, and weight loss.

These measures can help you notice possible areas of concern, but they should not be used alone. Ask what the facility is doing to prevent problems and support residents’ health, comfort, and daily life.

Measures for Short-Stay Residents

Short-stay residents need care or rehabilitation for a short time and often plan to return home. Quality measures for short-stay residents may include flu and pneumonia shots, delirium, pain, pressure sores, and progress toward returning to the community.

Tips for using quality measures:

  • Compare each home’s scores to state and local averages.
  • Remember that quality measures are only one part of the larger picture.
  • If you have questions, call 1-800-MEDICARE or your state Quality Improvement Organization, also called a QIO.
  • Do not make your choice based on numbers alone. You still need to visit and ask questions.

Cautions:

  • The numbers come from facility-reported information and resident assessments.
  • A home may do well in one area but have concerns in another.
  • Quality measures may not fully capture the daily experience of residents.

Visits to Nursing Homes

Always visit a home before you decide, if possible. Visits help you see how staff and residents interact. Talk with residents and families about life in the home. Ask about both care and costs.

Try to visit more than once, at different times, including evenings and weekends. Bring your loved one, if possible.

What to Look For

Use your senses to guide you:

  • Are call lights answered quickly and kindly?
  • Do staff respond when residents call out?
  • Do the meals look good? Are people eating?
  • Do staff help residents eat in a patient way?
  • Are any residents in restraints? If so, why?
  • Do rooms feel personal and homelike?
  • Are rooms, halls, and dining areas clean?
  • Is it too noisy?
  • Do staff speak to residents with respect and warmth?
  • Does the administrator know the residents and talk with them?
  • Do staff and leaders seem to work well together?
  • Do residents look clean, well-groomed, and well-fed?
  • Do many residents look alert, happy, or calm?
  • Are residents seated comfortably?
  • Does the home smell clean?
  • Are residents doing activities they seem to enjoy?

Questions to Ask Staff

  • Is there enough staff on each shift to give good care?
  • Do staff like working here? Do leaders listen to their ideas?
  • What activities do you offer?
  • Are staff assigned to the same residents most of the time?
  • Do you use temporary agency staff? How often?
  • How are nursing assistants included in care planning?
  • Are you using culture change or person-directed care practices? Pioneer Network website
  • How much training do staff get?
  • How often do residents get help with toileting?
  • If residents wear briefs, how often are they changed? Why are briefs used?
  • How do you avoid using physical or chemical restraints?
  • How do you include families and residents in care plan meetings?
  • What do you do to keep staff from leaving?
  • How long has the current administrator been here?
  • Has the home had recent ownership or management changes?
  • Do you provide rides to community events?
  • What therapy services are available?
  • Can you give an example of truly personalized care?
  • Is there a resident council or family council? Can I contact them?
  • How do you handle complaints or problems?
  • Are residents involved in picking roommates and meal seating?
  • When might a resident be moved or discharged?
  • Do you employ a social worker with a college degree in social work?

Questions to Ask Residents and Families

  • Are residents treated with respect and kindness?
  • Do residents get help with meals?
  • Can residents choose their schedule for sleep, baths, and meals?
  • If residents are awake at night, do they get attention and things to do?
  • Does the resident usually have the same nursing assistant?
  • Is there a family or resident council? Who leads it?
  • Do staff respond to requests, including help with toileting?
  • Are snacks, like fresh fruit, easy to get?
  • Do residents take part in care planning? Are their views valued?
  • Have there been problems with missing items?
  • Who handles concerns, and do they follow up?
  • Can residents go outside as often as they want?
  • What do they like best and least about this home?

The Importance of Fire Safety

Nursing homes must have strong plans to prevent and respond to fires. This is very important because many residents may be weak, may need help moving, or may not be able to leave the building on their own.

Federal rules require sprinklers in new or majorly rebuilt homes. Older homes may not have full sprinkler systems.

Ask about fire safety:

  • Is the building in good repair?
  • Are halls and doors clear of clutter and paper?
  • Are sprinklers, smoke alarms, and emergency lights in all areas?
  • Are these systems tested often?
  • Is there a written fire plan? Do staff practice drills?
  • Does the system alert the fire department right away?
  • What is the smoking policy?
  • How many staff are on duty for each shift, especially at night?
  • How will families be told if there is a fire?

The Emergency Evacuation Plan

By law, each nursing home must have an emergency plan. This plan covers natural disasters and other emergencies.

Ask staff about these areas:

The Plan

  • What is your evacuation plan?
  • What is your shelter-in-place plan for storms or other events?

Staffing

  • Are there enough staff on all shifts to carry out the plan?
  • How are staff trained for emergencies?
  • Do you hold drills on all shifts?

Coordination

  • Do you have plans with other facilities for housing residents if you must move them?
  • Do you have contracts with transportation companies?
  • Can those companies move everyone if more than one home needs help?
  • Do you work with city, county, and state emergency teams?

Supplies

  • What emergency supplies do you have, such as food, water, oxygen, generators, and flashlights?
  • Can you move these supplies if you must evacuate?
  • Can residents keep some emergency items in their rooms?

Resident Information

  • How do you tell residents about the plan?
  • How will you identify residents during an evacuation?
  • How will you move medicines and medical information?
  • Will these go with each resident or separately?

Role of the Family

  • How and when will you notify family members?
  • How can families help during an emergency?
  • Can families meet residents at a safe place?
  • Can families come to help at the facility?

Families may choose to move their loved one on their own to a special needs shelter or another safe location, depending on the emergency and the resident’s needs.

Information That Must Be Posted

Every nursing home must clearly post certain information. When you visit, look for it in a public area like the lobby. If you cannot find it, ask staff where it is.

Homes must post:

  • Daily staffing for each shift, including Registered Nurses, Licensed Practical Nurses, and nurse aides
  • Contact information for state advocacy offices, including:
    • The State Long-Term Care Ombudsman Program
    • The state survey agency
    • The protection and advocacy network
    • The Medicaid Fraud Control Unit
  • Results of the most recent state or federal survey, easy to see without asking staff

Family Involvement: Getting Good Nursing Home Care

Family involvement is key after your loved one moves into a nursing home. Your care, support, and presence help protect their quality of life.

You can:

  • Visit often and invite others to visit.
  • Speak up about concerns and complaints.
  • Attend care plan meetings and ask for personal, detailed plans.
  • Make sure the doctor knows what is in the care plan.
  • Ask for another meeting if the plan is not followed.
  • Help staff know your loved one by sharing written notes about likes, dislikes, and daily routines.
  • Join the family council, or help start one if it does not exist.
  • Stay in touch with the ombudsman and local advocacy groups.
  • Learn basic state and federal rules for nursing homes.
  • Write down any problems, including date, time, people involved, and what happened, so leaders or state agencies can review or investigate concerns.

Choosing a nursing home is difficult. Using several sources of information can help residents and families ask better questions, understand their options, and stay focused on what matters most: the resident’s rights, preferences, safety, care, and quality of life.

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