The beset way to evaluate a prospective nursing home is to visit it.

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The 85-and-older age group constitutes the fastest-growing segment of the U.S. population, according to statistics from the Centers for Disease Control and Prevention (CDC). While many of them will remain healthy enough to continue living independently in their own homes, some may not be able to continue managing basic activities of daily living, like dressing, bathing, and eating. At this point, nursing home placement may become necessary.

Even though the criteria for nursing home placement is strict, Sheila Barton, LCSW, social worker at Icahn School of Medicine at Mount Sinai, recommends that you research homes in your area well before one may be needed, particularly if you have multiple chronic conditions that may affect your ability to care for yourself down the road. “While you can’t apply for placement in advance, investigating your options ahead of any crisis that might arise means you can give more thought and time to your decision,” Barton advises.

Medicare Ratings: Useful Tool for Nursing Home Research

The Centers for Medicare and Medicaid Services (CMS) provides quality ratings for thousands of nursing homes across the U.S. The ratings are based on data from state health inspections, staffing reports, and quality measures that evaluate about 180 aspects of nursing home care, including how homes respond to things such as patients’ declining mobility, and pain.

Barton says the CMS ratings are a useful tool, but points to some limitations. “For example, there are differences in how states carry out the inspection process, even though the standards are the same across the country,” she says. “Also, staffing ratios are self-reported by nursing homes, and reflect only one two-week period during the year. She adds that the CMS ratings also may not take into consideration a home’s atmosphere, and the amount of freedom residents are allowed—for example, they may be able to get up in the mornings when they want to, decorate their rooms as they see fit, eat when they want to, have visitors by at any time, or even have a pet.

For these reasons, Barton believes it is best to see the CMS ratings as one of the many criteria you should consider when narrowing down a shortlist of possible nursing homes. “There still is no substitute for visiting a nursing home and meeting with residents and staff,” she says.

Nursing Home Quality of Life

When you visit a nursing home, spend time absorbing the environment of the entire building, including activity areas, the cafeteria, physical therapy or treatment areas, and anywhere else residents may spend time. “Use your nose in trying to detect the scent of urine or personal odors, which could indicate that residents aren’t cleaned or cared for in a timely manner,” Barton says.

Ask about social and recreational activities for residents, and whether they can engage in these at any time or must follow strict schedule. Are activities limited at weekends if staffing numbers are lighter? “If a resident has a hobby or special interest, is there a place where he or she can engage in this, and can they also engage in religious and cultural activities that are important to them?” Barton adds. “And is transportation provided to local community activities and events?”

Nursing Home Staff

Another important consideration for a prospective nursing home: personnel. Ask about staff turnover at each home you visit. “You’ll also want to get a picture of how the staff [members] interact with residents, so ask any residents you speak to if they feel they can communicate openly with the staff,” Barton says. “Speak to visitors too, as they will likely have been at the home at different times of day and when different staff members are on duty, and can provide insights as to how the day progresses for residents.”

Staffing ratios are also important—ask nursing home care managers how many caregivers are on duty at any one time, both during the day and at night. “Also ask if there is a registered nurse on duty at all times,” Barton advises.

Meals and Diet

Food is an important aspect of nursing home care. Ask to see a menu, and ask whether nutritious snacks are always available. You should also check as to whether there is a registered dietitian on staff, or if the home regularly consults with one.

Visit the kitchen—check if it’s clean, and that food is being hygienically stored, off the floor. Ask if you can see inside the refrigerators. “Dehydration is a risk among nursing home residents, so check that drinking water is always available,” Barton says.

Nursing Home Safety Concerns

During your visit, check for a nursing home’s safety features. Look for sprinklers, fire extinguishers, smoke alarms, and carbon monoxide detectors. Also, check to see whether there handrails in the hallways and grab bars in all of the bathrooms.

Is There a Dementia Unit?

Most nursing home placements are due to dementia, so make sure the homes on your shortlist have a dedicated dementia unit that tailors activities and staffing to the specific needs and concerns of dementia patients.

Health Precautions

Infectious disease can spread rapidly in a nursing home. A recent study (Infection Control & Hospital Epidemiology, Jan. 9) details how an outbreak of respiratory syncytial virus (RSV) and human metapneumovirus (HMPV) at a long-term dementia care ward infected 73 percent of the patients, five of whom died. “It is important that you ask if the nursing home has a preventive health program that includes immunizations against flu and pneumonia,” Barton adds. “Also check the home’s policy for health emergencies—will it send you to a hospital where your personal physician has privileges?”