Choosing a nursing home is one of the most consequential decisions a family will ever make. With more than 15,000 Medicare- and Medicaid-certified facilities in the United States, the options can feel overwhelming, but a structured approach makes it manageable.
Step 1: Define the Level of Care Needed
Not all facilities offer the same services. Before you search, clarify whether your loved one needs skilled nursing care (wound care, IV therapy, physical rehabilitation), long-term custodial care, memory care, or a combination. A physician's assessment is essential here.
- Skilled Nursing Facility (SNF): post-acute rehab, 24/7 RN, covered short-term by Medicare
- Long-term care: ongoing custodial assistance, typically Medicaid or private pay
- Memory care unit: secure environment for dementia patients with specialized programming
Step 2: Check CMS Star Ratings
The Centers for Medicare & Medicaid Services (CMS) rates every certified nursing home on a 1–5 star scale across three dimensions: health inspections, staffing, and quality measures. A 5-star overall rating does not mean 5 stars in every category. Always drill into each component. CareScope surfaces all three sub-ratings for every facility in our database.
Step 3: Read the Inspection Report
Every nursing home receives an unannounced health inspection at least annually. The resulting report lists "deficiencies" (regulatory violations) coded by scope (isolated, pattern, widespread) and severity (A through L, with G–L indicating actual harm). Look for any citations in categories F600–F610 (abuse/neglect) and F689 (accident hazards). These are red flags regardless of star rating.
Step 4: Evaluate Staffing
Federal minimum staffing rules were repealed in December 2025. Now each state sets its own requirements, and many states have no minimums at all. Use CareScope to compare a facility's reported RN hours per resident day against the state and national averages. Higher staffing consistently correlates with better quality outcomes.
Step 5: Tour in Person
No data replaces a tour. Visit at multiple times of day, including evenings and weekends when staffing is typically thinner. Observe how staff interact with residents, whether call lights are answered promptly, and whether common areas feel active or deserted.
- Notice smell: persistent odors often indicate understaffing
- Talk to current residents and families in the hallway
- Ask to see the most recent state inspection report (they must provide it)
- Request the facility's staffing report for the past 90 days
Step 6: Understand Costs and Contracts
The national average private room runs $10,798/month (2026). Review what the base rate includes versus what triggers extra charges. Get the admission agreement reviewed by an elder-law attorney before signing.
Use CareScope's facility search to filter 15,000+ facilities by location, star rating, and care specialization, and compare up to three side by side.