Nursing home tour checklist: what to ask and watch for

Staffing — ask these first

How many RNs and aides are on each shift, for how many residents?
Understaffing is the strongest predictor of harm. Compare their answer with the reported hours on this site.
Is weekend staffing the same as weekdays?
Many facilities run thinner on weekends. Visit on a Saturday to see for yourself.
How long have the director of nursing and administrator been here?
Leadership turnover usually shows up in care quality within months.
Do you use agency (temp) nurses? How often?
Heavy agency use means staff who don't know the residents.

The inspection record

Ask about each red flag on this facility's page: "What happened, and what changed?"
A good facility answers plainly and shows you the fix. Deflection is an answer too.
Ask to see their most recent state survey (Form 2567).
They must make it available to you — hesitation there tells you plenty.

Look and listen on the walk-through

Are call lights being answered within a few minutes?
Count for yourself while you wait. Slow call lights mean falls and worse.
Do staff know residents' names? Do they knock before entering rooms?
Dignity in small moments predicts dignity when it's hard.
Any smell of urine, or heavy air freshener covering it?
Persistent odor means residents wait too long for continence care.
Are residents up, dressed, and engaged mid-morning — or parked in hallways?
Mid-morning is peak activity time in a well-run facility.
Taste the food. Ask how residents who need feeding help get it.
Unassisted mealtimes are a common citation behind weight loss and dehydration.

Money and contracts

What exactly does the base rate include, and what costs extra?
Laundry, incontinence supplies, therapy — surprise add-ons strain families fast.
What happens when private funds run out — do you keep Medicaid residents?
Some facilities discharge residents who transition to Medicaid. Get the policy in writing.
Never sign an arbitration agreement on the spot.
You usually don't have to sign it at all to be admitted, and it limits your options if something goes wrong.

After the tour

Come back unannounced at a different time — an evening or weekend.
The 10 a.m. weekday tour is the facility at its best.
Talk to a family member of a current resident in the parking lot or lobby.
Ask one question: "Would you place your mom here again?"
Ask the ombudsman's office about complaints on file.
Every state has a free long-term-care ombudsman — they hear what inspectors miss.

Two more free tools while you're deciding: search the facility's full inspection record, and save your candidates to a shortlist so we can email you if a new serious citation appears.

The tour checklist

Staffing — ask these first

The inspection record

Look and listen on the walk-through

Money and contracts

After the tour