Choosing a nursing home is one of the most consequential decisions a family will make. Quality varies enormously between facilities — even in the same town. This guide walks you through the exact steps to find the right fit for your loved one’s needs, budget, and preferences.
Step 1: Define the Type of Care Needed
Before comparing facilities, clarify what level of care your loved one actually requires:
- Short-term rehab: After a hip replacement, stroke, or cardiac event — typically 2–6 weeks of skilled therapy
- Long-term skilled nursing: Ongoing nursing care for complex medical conditions (feeding tubes, wound care, dementia with behavioral needs)
- Long-term custodial care: Help with daily activities when independent living is no longer safe
- Specialized memory care: Secure units for Alzheimer’s and dementia with behavioral symptoms
Step 2: Use Medicare’s Nursing Home Compare Tool
The Medicare Care Compare database rates every Medicare-certified nursing home on a 1–5 star scale. Search by ZIP code and filter by:
- Overall star rating (aim for 4–5 stars)
- Staffing rating (this is the most predictive of care quality)
- Health inspection results
- Quality measures
Download the most recent inspection report for any facility you’re seriously considering. Look for citation patterns — repeated violations in the same category are a red flag.
Step 3: Consider Location and Accessibility
Research consistently shows that residents whose family visits frequently have better outcomes. Choose a facility that family members can realistically visit 2–3 times per week:
- Drive time from home (under 30 minutes is ideal)
- Parking availability
- Visiting hours and flexibility
- Outdoor spaces for family visits
Step 4: Schedule Tours and Ask the Right Questions
Visit your top 2–3 choices in person. Tour during a weekday, ideally around a mealtime or activity. Observe how staff interact with residents. Use our complete nursing home checklist →
Key things to ask during your tour:
- What is the RN staffing level per resident?
- Is there a registered nurse on site 24 hours a day?
- What is the facility’s policy on hospitalizations?
- How does the facility communicate with family members?
- What activities and social programming are available?
- What is the average length of stay for rehab patients?
See our full list of questions to ask →
Step 5: Evaluate Staffing — the Most Important Factor
Staffing is the single strongest predictor of nursing home quality. Look for:
- RN hours per resident day: The national average is about 0.5 hours. Aim for facilities at or above average.
- Total nursing hours per resident day: CMS recommends at least 4.1 hours; industry consensus is higher is better
- Staff turnover rate: Facilities with low turnover have more experienced, invested staff
- Consistent assignment: Residents do better when the same aides care for them daily
Red Flags to Watch For
Trust your instincts. Walk away if you observe:
- Strong odors (urine or feces in common areas indicates understaffing)
- Residents in hallways appearing unattended or in distress
- Staff who seem rushed or dismissive during your tour
- Multiple deficiency citations for the same issue in recent inspections
- Inability or reluctance to answer direct questions about staffing ratios
- Pressure to sign admission agreements immediately without time to review
Full guide to nursing home red flags →
Frequently Asked Questions
Q: How long does it take to get into a nursing home?
A: Placement can happen in as little as 24–72 hours after a hospital discharge if a bed is available. For non-urgent placement, the process typically takes 1–3 weeks including facility selection and financial paperwork.
Q: Can you choose any nursing home you want?
A: If you’re paying privately, yes. If Medicare is paying, you can choose any Medicare-certified SNF that has a bed available and accepts Medicare assignment. Medicaid requires the facility to have a Medicaid-certified bed.
Q: What if the nursing home I want doesn’t have availability?
A: Ask to be placed on the waitlist. In the meantime, you may need to temporarily accept placement at a second-choice facility. Transfers between facilities are common and permitted.
Get Expert Help Choosing a Nursing Home in Missouri
A Place for Mom’s local care advisors have toured the facilities in Jefferson County and the St. Louis area — and can match your loved one’s specific needs to the right facility.
Find the Right Nursing Home →Related Resources
April 19, 2026