Guidelines For Selecting A Nursing Home

The following is an interview conducted online by CBS News Producer Theresa Bujnoch with Eileen Kraatz, author of A Spy in the Nursing Home.

Kraatz has worked in nursing homes as a staff member and a volunteer for more than 20 years. She now lives in Ontario, Canada, where she continues her advocacy work and trains nursing home volunteers. Kraatz welcomes email questions. Her address is

What is the first thing a family should take into consideration in choosing a nursing home?

The first thing to consider is the quality of care and the dignity given to each resident. This can only be assessed by careful observation and your own investigation.

How important is it to bring along a checklist?

It's extremely important. The checklist keeps you focused on your investigation and also lets the administration and staff see that you know what to look for and that you are an educated consumer.

What are the key questions to ask?

There are so many questions that must be asked, but if I had to narrow it down, I'd ask:

1. Is the facility certified by Medicare and Medicaid and all rooms as well?

2. Insist on seeing the latest state inspection report and check the date! Make sure you see the actual report and not a "copy" or summary.

3. What is the turnover of nursing staff, particularly part-time LPNs and nurses' aides?

What are the key things to look for?

Again, there is so much! Use all your senses (smell, sight, sound, taste and intuition). Are there a lot of residents with bruises on their faces or arms? Are there a lot of residents tied in wheelchairs? Are the bedridden residents receiving prompt attention and privacy?

How important is it to talk to other residents?

It is very important to talk to other residents as long as they don't feel threatened. Many residents fear reprisal if they criticize the facility or staff. Watch their reactions and body language when they answer your questions and don't push them to answer.

Do people tend to make the mistake of choosing a place too quickly and visiting too few facilities?

Definitely. Too often people will take a look at a nursing home based on cleanliness and decor and think the place is great. Cleanliness is important but looks are often deceiving. People need to take time and look at what's going on behind the scenes. And yes, they often don't go to enough facilities.

But there is a point where you have to narrow the search down. If you know what you're looking for and you're using the checklists, it's not difficult to narrow the choices down to one or two homes.

What are some other common mistakes?

People often assume that the food is good because the home "looks" good. You must check the food out. Order a meal. Ask to see the kitchen. Another big mistake is assuming that residents will receive help when needed to eat.

Too often peopl who need assistance cutting food, opening milk cartons, holding a fork or spoon just don't receive help since there's not enough staff. Consequently, these people go hungry and at the end of the meal time their plate is just taken away.

Check this out on a Saturday. Also, don't assume that the social activities scheduled actually happen! Many times activities are listed but never occur. People must check these things out for themselves.

Is the cost of a home a reasonable indicator of the quality of the home?

Definitely not! Most people think that the more a home costs, the better the care. Not so! Any nursing facility must be checked out regardless of the cost. I've seen very expensive homes where the care is negligible and staff are rarely visible.

Finally, how dangerous can some homes be? There's probably a misconception that if a place is open and licensed, it can't be "too bad."

Homes can be safe or dangerous. It all depends on the staff and the quality of care. Problems of neglect, abuse and disregard of residents' dignity can all occur in a home that is open and licensed. Never assume that a place is good. Continue to check it out even after you have placed your loved one there.