Choosing a Facility
How to Choose a Nursing Home: A Checklist From CMS
How Do You Choose a Nursing Home?
To choose a nursing home, follow Medicare's four steps: list the certified homes near you, compare their CMS star ratings, inspections and staffing, visit with Medicare's checklist, then pick the home that fits your parent's needs and can be visited often. In August 2026 data, CMS rated 5,766 of 14,690 nursing homes 4 or 5 stars overall. Start with the nursing home finder and narrow to two or three homes to tour.
Most families pick a nursing home under pressure, often from a hospital bed with a discharge date already set. The good news is that every Medicare- or Medicaid-certified home is inspected and rated by the same federal system, so you can compare homes side by side in an evening and spend your visits on the things no rating can show.
This guide follows Medicare’s own process and checklist, and shows you where the numbers live and what to ask about them.
How to Choose a Nursing Home in Four Steps
Medicare lays out the same four steps for every family. The order matters, because each step narrows the list for the next one.
- Research the homes near you. Use the nursing home finder or Medicare’s Care Compare to list certified homes by city or ZIP code. Ask people you trust about their experience, and ask your parent’s doctor which local homes they visit, so your parent may be able to keep the same doctor. If your parent is in the hospital, ask the social worker about discharge planning as early as possible.
- Compare quality. Medicare points you to three things: health inspection results, staffing and quality measures. All three feed the CMS star ratings.
- Visit, or send someone you trust. Take Medicare’s nursing home checklist and use a fresh copy for each home.
- Choose the home that best meets your parent’s needs. Talk it through with the people who know your parent’s health and personal needs: family, the doctor, a clergy member, the hospital discharge planner or a social worker.
If the decision feels impossible, the Eldercare Locator (1-800-677-1116) connects you with your local Area Agency on Aging, and your state’s Long-Term Care Ombudsman can tell you what complaints they see. The residents’ rights and ombudsman guide explains how to reach them.
What a Good Nursing Home Looks Like in the CMS Data
CMS gives every certified nursing home an overall rating from 1 to 5 stars, plus separate ratings for health inspections, staffing and quality measures. In August 2026 data, CMS rated 2,981 nursing homes 5 stars overall and 5,766 homes 4 or 5 stars, out of 14,690. The national average was 2.98 stars, and 5,977 homes were rated 1 or 2 stars.
Two things about the overall rating help you read it correctly:
- The inspection rating carries the most weight. CMS starts with the health inspection rating, then adds or subtracts a star based on staffing and another based on quality measures.
- Inspection stars compare homes within the same state. A 4-star inspection rating in one state isn’t directly comparable with a 4-star rating in another. Compare homes in the same area.
Look past the overall stars at the measures that matter for your parent. For long-stay residents, the national median for antipsychotic use was 13.37% in the 2025Q2-2026Q1 measure period, falls with major injury 2.85% and pressure ulcers 4.17%. The median nursing home reported 3.68 nurse staffing hours per resident per day, with 0.58 of those from registered nurses, and a nursing staff turnover rate of 44.9%. A home well below the median on falls and antipsychotic use, and above it on staffing hours, is worth a visit.
The star ratings guide explains each rating in depth, and the Nursing Home Comparison tool lines up these measures for up to three homes at once.
Red Flags to Check Before You Tour
Three markers on Care Compare call for a closer look:
| Marker | What it means | Homes in CMS data (August 2026) |
|---|---|---|
| Abuse icon | CMS found an abuse citation with harm, or repeat abuse citations. The home’s inspection rating is capped at 2 stars, so its overall rating can’t be higher than 4. | 1,426 |
| Special Focus Facility | The home has a history of serious quality problems. It gets no star ratings, a yellow warning sign instead, and inspections at least every six months. | 525 |
| Fines or payment denials | CMS fined the home or denied Medicare or Medicaid payment after a finding. | 7,915 homes had none on record |
None of these means a home is unsafe today. Each means CMS recorded something you should read about in the inspection report. Ask the administrator what happened and what changed. The inspection reports guide shows you how to read the findings, and the abuse warning signs guide covers what to watch for after admission.
On the positive side, starting with the September 2026 refresh, CMS adds a trophy icon to high-performing homes with fewer citations and higher staffing.
4 or 5 Stars Overall: Nursing Homes by State
CMS Care Compare lists 5,766 nursing homes in this group (4 or 5 stars overall) across 52 states and territories, data from August 2026. Pick a state for its nursing homes, cities and senior care rules.
Questions to Ask on the Tour
Medicare’s checklist runs to several pages. These are the questions that most often separate one home from another:
| Topic | Ask or check |
|---|---|
| Certification | Is the home Medicare- and Medicaid-certified, and are the home and its administrator licensed in your state? |
| Special care | Is there a dementia care unit or other specialized service your parent needs? Is a bed available? |
| Costs | Will the home give you its services, charges and fees in writing before admission? What costs extra? |
| Nurses | Is a registered nurse on site at least 8 hours a day, 7 days a week? Where is today’s staffing sheet posted? |
| Leadership | Has the administrator or director of nursing changed in the past year? |
| Daily life | Can your parent choose when to get up, go to sleep and bathe? Can visitors come at any time? |
| Rooms | Can residents bring furniture and belongings? Is there a choice of roommate? |
| Inspections | What did the last inspection find, and have all deficiencies been corrected? |
| Dementia care | Does the home try non-medication approaches first for behavioral symptoms? What is its current rate of antipsychotic use? |
Two of these are federal requirements you can check on the spot. A certified home must post its nurse staffing every day at the start of each shift: the number of registered nurses, licensed practical nurses and certified nurse aides on duty, their hours, and the resident count. It must also post the results of its most recent inspection where residents and families can see them, and show you the last three years of inspection and complaint reports on request.
Medicare also suggests asking which doctors will care for your parent, what therapy is offered and whether therapists are there every day, and how the home handles flu, COVID-19 and pneumonia vaccinations.
What to Notice While You Walk Through
Ratings come from records. Your visit shows you the people. Medicare’s checklist asks you to notice:
- Smell, light and noise. Is the home free of strong unpleasant odors, clean, well lit and comfortable in temperature? Is the dining room calm enough to talk in?
- How staff treat residents. Do staff knock before entering rooms, call residents by name and wear name tags? Does the tone feel warm and respectful?
- Residents themselves. Are they clean, groomed and dressed for the time of day? Are people engaged in activities, including those who can’t leave their rooms?
- Mealtimes. Is there a choice of food, help for residents who need it, and snacks on request? Can the kitchen handle special diets?
- Safety. Are exits marked, handrails and grab bars in place, and hallways wide enough for wheelchairs?
If you can, ask to sit in on a resident or family council meeting and ask what improved in the last year. CMS data showed 1,811 nursing homes with a family council in August 2026. Then go back a second time on a different day and at a different hour. Medicare points out that staffing can look different in the evening and on weekends. The staffing guide explains how to compare what you see with the payroll data CMS publishes.
If your parent is living with dementia, ask how the home responds to agitation or distress. The antipsychotics guide explains the national measure and what to ask.
Choosing Quickly After a Hospital Stay
Many nursing home moves start with a hospital discharge, often for short-term rehab. You still have choices, but the clock is real.
- Ask for the list early. The hospital’s discharge planner can help you find a home that meets your parent’s needs and arrange the transfer.
- Screen by phone. Check the CMS data for each home on the list, then call the top two or three to confirm a bed and ask the key checklist questions.
- Know the cost of waiting. If you turn down a home with a bed, Medicare says the discharge planner or doctor may help find another home or arrange short-term home care. If your parent stays in the hospital while you wait, you may owe the full amount for the extra days.
Short-term rehab and long-term care are paid for differently, so ask the hospital which one the stay is.
Who Pays for the Nursing Home You Choose
Money often narrows the list before quality does, so settle the payment question early.
- Medicare Part A covers skilled nursing facility care on a short-term basis, after a qualifying inpatient hospital stay of at least 3 days in a row. Time under observation doesn’t count. Medicare doesn’t pay for long-term custodial care in a nursing home. The Medicare nursing home guide explains the rules.
- Medicaid pays for long-term nursing home care for people who meet their state’s income and asset rules. In August 2026 data, 14,151 nursing homes were Medicaid certified, but a certified home may not have a Medicaid bed open. Ask directly. The Medicaid eligibility guide and the Medicaid Long-Term Care Checker show the 2026 limits.
- Veterans may have VA options; CMS data lists 122 veterans homes among certified nursing homes. See the VA long-term care guide.
- Private pay and long-term care insurance cover the rest. The guide to paying for a nursing home puts every option side by side.
If your parent may run through savings and need Medicaid later, ask each home whether residents can stay in the same bed when they switch from private pay to Medicaid.
If the Home You Choose Doesn’t Work Out
A choice isn’t permanent. Medicare says a resident who moves in and is unhappy can move to another facility with an available bed. Ask the home about its rules for leaving, because you may need to give notice and could owe fees if you don’t follow them. A move in or out of a nursing home also lets your parent switch Medicare drug plans.
Before moving, raise the problem with the staff involved, then the director of nursing or administrator, and bring in the ombudsman if it isn’t resolved. If you ever believe your parent is in immediate danger, call 911.
Ready to start? Search the nursing home finder, or browse the largest markets, such as Los Angeles, Chicago, Houston and Philadelphia. Your state page also lists each state’s highest-rated homes, such as the highest-rated nursing homes in California. If you’re still deciding between settings, the assisted living vs nursing home guide and the Care Options Guide can help.
Frequently Asked Questions
How Many Nursing Homes Should You Visit Before Deciding?
Medicare's guidance is to visit the homes you're considering before you make a final decision and to use a new checklist for each one. Two or three serious candidates is a workable number for most families. Medicare also suggests a second visit on a different day and at a different time, because staffing can change on evenings and weekends.
Can Someone Else Tour the Nursing Home for Me?
Yes. Medicare says that if you can't visit yourself, you can ask a family member or friend to visit for you. Give them the Medicare checklist and your parent's must-haves, and ask them to photograph the room, the dining area and the posted daily staffing sheet.
Is a Nursing Home Near Family Better Than a Higher-Rated One Farther Away?
It can be. CMS's own star-rating page cautions that visits can improve residents' quality of life and care, so a home that is very close may be a better choice than one rated higher but far away. Use the ratings to rule out homes with serious problems, then weigh distance.
Do I Have to Take the First Bed the Hospital Offers?
No, but act quickly. Medicare says that if you turn down a home with a bed, the discharge planner or doctor may help you find another home or arrange short-term home care. If you stay in the hospital while you wait, you may owe the full cost of the extra days.
What Paperwork Should the Nursing Home Give Me Before Admission?
Medicare's checklist notes that certified nursing homes must tell you in writing about their services, charges and fees before you move in. Ask for the fee schedule so you can see what the daily rate includes and what costs extra, such as beauty shop services.
Can My Parent Keep Their Own Doctor in a Nursing Home?
Federal rules give every resident the right to choose their attending physician, as long as that doctor is licensed and meets the nursing home rules. Medicare suggests asking whether your doctor already provides care at any local nursing homes, and whether the home helps arrange transportation to outside appointments.
More on Choosing a Facility
- Star Ratings ExplainedWhat each Care Compare star rating measures and its limits
- Inspection ReportsDeficiencies, scope and severity, fines and where to find reports
- Staffing and TurnoverNurse staffing hours, turnover and the federal staffing data
- Antipsychotic UseThe FDA warning for dementia, CMS's measure and what to ask
- Abuse Warning SignsWarning signs, CMS's abuse icon and who to call
- Residents' RightsFederal residents' rights and the free ombudsman program
This guide explains long-term care in plain language from official sources. It isn't medical, legal or financial advice; a doctor, your state Medicaid agency or an elder law attorney can advise on your situation.
Sources
- Medicare.gov: How do I choose a nursing home?
- Medicare.gov: Nursing home checklist
- CMS: Five-Star Quality Rating System
- CMS: Nursing Home Five-Star Quality Rating System, Technical Users' Guide (September 2026)
- CMS: Special Focus Facility Program with candidates list (September 2026)
- eCFR: 42 CFR 483.10, Resident rights
- eCFR: 42 CFR 483.35, Nursing services
- Medicare.gov: Skilled nursing facility care
- Medicare.gov: Long-term care
- CMS Provider Data Catalog: Nursing Home Provider Information (August 2026)