25 Questions to Ask on a Nursing Home Tour — and the Answers That Should Worry You

Staffing

• What are your total nurse hours per resident per day, and how many are RN hours? (Compare with the figure on our grade page — it comes from payroll data the facility files with CMS.)
• What is your annual staff turnover? CMS now publishes this; above 50% is common and above 70% is a warning.
• Is there an RN on site 24 hours a day?
• How many residents does one aide care for on the day shift, the evening shift and at night?

Safety and care

• May I see your latest CMS-2567 inspection report and plan of correction?
• How do you prevent falls and pressure ulcers, and what are your rates?
• What is your policy on antipsychotic medication for residents with dementia?
• How do you handle a resident who wanders?
• What happens when a resident's condition changes at night — who decides on a hospital transfer?

Daily life

• Can residents choose when to wake, eat and bathe?
• Is there a resident council and a family council, and when do they meet?
• What activities happened this week? Ask to see the calendar and then look for evidence they took place.
• Can we visit at any hour?

Money

• What is the daily rate, and what is not included?
• Do you accept Medicaid, and will a resident who spends down be able to stay?
• What is the bed-hold policy during a hospital stay?
• Is there an arbitration clause in the admission agreement? (CMS rules prohibit requiring one as a condition of admission.)

What should worry you

Call lights that ring for more than a few minutes, strong odours, residents parked in hallways without engagement, staff who cannot answer the staffing question, and any reluctance to show the inspection report. Visit twice — once by appointment and once unannounced at a mealtime or in the evening.