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The Ribbon - Care for Caregivers

Nursing Home Checklist

This checklist is designed to help you evaluate and compare the nursing homes that you visit. It would be a good idea to make several copies of this checklist, so that you will have a new checklist for each home you visit. After you have completed checklists on all the nursing homes you plan on visiting, compare your checklists. Comparisons will be helpful in selecting the nursing homes that might be the best choice for you.

Part 1 - Basic Information
Name of Nursing Home: 
Address: 
Phone: 
Cultural/Religious Affiliation (if any): 
 
Medicaid Certified?YesNo
Medicare Certified?YesNo
Admitting New Residents?YesNo
Convenient Location?YesNo
Home capable of meeting your special care needs?YesNo
 
For parts two through five, rate the nursing home on a scale from one to ten, with ten being a perfect score.
 
Part 2 - Quality of Life
1. Are residents treated respectfully by staff at all times? 12345678910
2. Are residents dressed appropriately and well-groomed? 12345678910
3. Does staff make an effort to meet the needs of each resident? 12345678910
4. Is there a variety of activities to meet the needs of individual residents? 12345678910
5. Is the food attractive and tasty? (sample a meal if possible) 12345678910
6. Are resident rooms decorated with personal articles? 12345678910
7. Is the home's environment homelike? 12345678910
8. Do common areas and resident rooms contain comfortable furniture? 12345678910
9. Does the facility have a family and residents' council? 12345678910
10. Does the facility have contact with outside groups of volunteers? 12345678910
 
Part 3 - Quality of Care
11. Does staff encourage residents to act independently? 12345678910
12. Does facility staff respond quickly to calls for assistance? 12345678910
13. Are residents and family involved in resident care planning? 12345678910
14. Does the home offer appropriate therapies (physical, speech, etc.)? 12345678910
15. Does the nursing home have an arrangement with a nearby hospital? 12345678910
 
Part 4 - Safety
16. Are there enough staff to appropriately provide care to residents? 12345678910
17. Are there handrails in the hallways and grab bars in bathrooms? 12345678910
18. Is the inside of the home in good repair and exits clearly marked? 12345678910
19. Are spills and other accidents cleaned up quickly? 12345678910
20. Are the hallways free of clutter and well-lighted? 12345678910
 
Part 5 - Other Concerns
21. Does the home have outdoor areas (patios, etc.) for resident use? 12345678910
22. Does the home provide an updated list of references? 12345678910
23. Are the latest survey reports and lists or resident rights posted? 12345678910
24. (Your Concern) 12345678910
25. (Your Concern) 12345678910
 
Additional Comments:  

This checklist may be reproduced and circulated. It is designed to be used in concert with the Health Care Financing Administrations booklet, The Guide to Choosing a Nursing Home. This booklet can be obtained by calling (800) 638-6833.

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