What To Look For When Touring a Nursing Home

What to Look for When Touring a Nursing Home

Choosing a nursing home for long term care requires a great deal of consideration and evaluation.  Since you may not have the time or ability to tour all the facilities in your area, it’s important to begin the process by conducting online research and seeking feedback from family and friends, neighbors, and local healthcare providers.  From this preliminary research, you may choose a few nursing homes to visit in-person. 

 In this article, I’ll offer some important tips for making the most of each tour experience. 

Touring a nursing home is an opportunity to get an overall sense of the environment.  You want to rely on your senses and first impressions.  Other advisors may recommend asking your tour-guide a list of general questions with the goal of evaluating quality of care.  What I’m about to say may sound strange… The tour is not the time to ask a lot of questions.  The tour is the time to use all your senses to make an initial evaluation of the care environment.       

Make an appointment for a tour OR just drop in?

You can do either.  Making an appointment in advance should guarantee that you’ll have ample time with the admissions director.  However, sometimes just dropping by for a brief tour might make the best sense.  I wouldn’t advise doing this in the evenings or weekends when admissions staff are generally not onsite.  You can learn a lot by just showing up.    

• Will the admissions staff make time for you? (priorities)
• If they are unable, will another member of the administrative staff offer to give you a tour? (teamwork)
• Is the receptionist friendly when you “just show up” and ask for a tour or is there a sense that you’ve created an inconvenience by not making an appointment in advance? (tone)

Before the Tour Begins 

While you’re waiting for your tour to begin, take a moment to look around (and smell) the lobby.  Is it bright, comfortable, and well-ventilated?  You’ll want to compare this impression to other resident areas in the facility during the tour.

While in the entrance, look for evidence of posted announcements and other information about the facility. You should find information on:

• staffing patterns
• name and contact info for the long-term care Ombudsman
• state operating license, with names of Administrator, Director of Nurses, and Medical Director
• statement of participation in Medicare and Medicaid programs
• location of recent state and federal inspection results

Before your tour begins, ask to use the visitor restroom while you’re waiting.  If you wish you brought your own batch of Lysol wipes, that’s an impression to hold on to!

Assessing the Environment and Facilities

Cleanliness and Maintenance: Common Areas

Check for the cleanliness and maintenance of the facility.

Look up, down, and side to side and consider the following:  

• Are there stained ceiling tiles, dust-laden air vents, stained carpeting, missing floor tiles, detached molding, torn wallpaper, damaged walls, chipped paint? 

Remember: this is a very active environment with residents, visitors, and staff active 24-hrs/ day so the interior of the building will experience normal “wear and tear.”  The question is not if there is a single stained ceiling tile, for instance, but if there are several indicating a leaking pipe that hasn’t been repaired.

Pay attention to all the smells you experience while touring the building. 

• Are there pleasant smells like newly made popcorn, baked cookies, fresh flowers, or fresh air from an open window? 
• Did the entrance area smell different from the resident areas?  

Be prepared for the less than pleasant odors you may experience.  You may come across an occasional “post-bathroom use” odor not different from what you might encounter in your own home.  This is life and there are lots of people using the bathroom, so to speak, in a nursing home.  The issue is if these smells are pervasive and strong, i.e. not just an unfortunate odor, in passing.  This could indicate a larger issue with cleanliness and maintenance of the facility.  There is no reason for a nursing home to “smell like a nursing home.”       

• Don’t be afraid to touch railings, doorknobs, walls, and countertops when touring the building.  Are any of these surfaces dusty or grimy?  Are you able to easily find hand sanitizer dispensers throughout the building?

Cleanliness and Maintenance: Resident Rooms 

A standard nursing home tour will show you an open, unoccupied room if available.  This is an opportunity to get a sense of the size of the room, private or semi-private, and the condition of the furnishings, walls, ceilings, and floors. 

Unoccupied rooms are a great opportunity for maintenance staff to touch up walls, flooring, window coverings, and anything else that may need a quick repair.  Given the heavy equipment used in nursing homes (ex. patient lifts) and the size of some custom wheelchairs, it is not unusual for walls to get scuffed or damaged on occasion.  The question to ask yourself is if you see efforts to make repairs to the internal environment when it’s needed.     

During your tour, ask to see an occupied room if possible.  When asked, often a nursing home resident is delighted to show a visitor their room.  This is also a great opportunity to ask the resident about their experience at the facility. While each occupied room will look different, with different levels of personalization, you should be able to see evidence that basic, daily housekeeping is taking place, and that staff is helping to keep the space neat and organized.    

Amenities and Activities

Look for common areas for residents and their guests to gather (indoors and outdoors) and a calendar of activities that encourage social interaction and cognitive stimulation. Ask for a copy of the monthly recreation calendar. Group activities should appeal to a variety of interests and accommodate different abilities, so all residents are able to participate and benefit.

At some point during your tour, you should be able to walk through a dining room or take a peak when residents are having a meal together.

• Does the dining room have adequate lighting and appear friendly and accommodating?
• Are the tables set in advance with linens or are they bare?
• Are food trays distributed or are meals served directly from a hot service station?

Ask to see a copy of the menu.

• Is there a variety of offerings for each meal?
• Does the menu use fresh, seasonal fruits and vegetables?
• Would you want to eat a meal at the facility?  By all means, if you’re offered a sample meal -take it.  Taste is another sense that can help you evaluate the care environment.

Evaluating Quality of Care

 When touring a nursing home for your loved one, you want to come away with an assurance that high quality care is provided with compassion and expertise. Your sense perceptions and brief observations will give you a first impression that can be further developed with post-tour questions and off-site research.

Interactions with Staff

Over the course of your tour, you will walk through many areas of the facility presumably passing by staff and residents.  Take note of any of the following observations you may have:

• Did the staff seem at ease and friendly when you walked by, or did it feel like you may have been intruding?
• Were you able to tell who was a staff member vs. another visitor?  (Some facilities may not require department identifying uniforms, but all nursing home employees/ temporary staff must wear ID badges.)
• Did staff and/or residents say “hello” to you?
• Did you see smiles and hear laughter?
• Did staff appear stressed and distracted?
• Were the resident areas loud with multiple call bells going off and sounds of alarms ringing?
• Were residents calling out for assistance?
• Did staff speak to residents by name?
• Was there an emotional warmth to the environment, i.e. did it feel like people knew each other and connected with each other in a manner that was calm, kind, and respectful?

You’ll be able to tune into the dynamics of the environment quickly.  A call bell or two going off at the same time is not an issue.  It means the initiation of that communication loop is working.  If the call bells are going off but staff seem distracted or “on break” then it’s fair to assume there may be competing priorities above patient care.  

Daily Care and Assistance

During your tour, you won’t be invited to observe resident care.  (If you are, please decline. That indicates larger issues for another blog!)  Since you are primarily touring common areas, you can witness interactions between staff and residents in these communal spaces only. These observations will provide valuable insight into the quality of care given at the facility.

Notice if you observed any of the following: 

• Residents with “bed head” or residents that generally look unkempt.
• Residents wearing clothing with stains or outside of their rooms in hospital gowns.
• Wheelchairs that are significantly dirty or in disrepair.
• Residents given medication or other treatments in a common area without privacy.

Consider the following:

• If using a wheelchair, does the resident look comfortably seated?
• If you came across any unpleasant odors, were they temporary and site specific OR strong and pervasive?

In Conclusion 

Touring one or more nursing homes is an invaluable step in deciding which facility is best for your loved one. The observations made during a tour, in addition to prior research and word of mouth recommendations, helps you make the most informed decision about nursing home placement. Use the tour to gather first-hand observations about the care environment.  There will be time at the end of the tour, or at a later date, to ask important follow up questions. 

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