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?	Yes					No
Medicare Certified?	Yes					No
Admitting New Residents?	Yes					No
Convenient Location?	Yes					No
Home capable of meeting your special care needs?	Yes					No

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?	1	2	3	4	5	6	7	8	9	10
2. Are residents dressed appropriately and well-groomed?	1	2	3	4	5	6	7	8	9	10
3. Does staff make an effort to meet the needs of each resident?	1	2	3	4	5	6	7	8	9	10
4. Is there a variety of activities to meet the needs of individual residents?	1	2	3	4	5	6	7	8	9	10
5. Is the food attractive and tasty? (sample a meal if possible)	1	2	3	4	5	6	7	8	9	10
6. Are resident rooms decorated with personal articles?	1	2	3	4	5	6	7	8	9	10
7. Is the home's environment homelike?	1	2	3	4	5	6	7	8	9	10
8. Do common areas and resident rooms contain comfortable furniture?	1	2	3	4	5	6	7	8	9	10
9. Does the facility have a family and residents' council?	1	2	3	4	5	6	7	8	9	10
10. Does the facility have contact with outside groups of volunteers?	1	2	3	4	5	6	7	8	9	10

Part 3 - Quality of Care
11. Does staff encourage residents to act independently?	1	2	3	4	5	6	7	8	9	10
12. Does facility staff respond quickly to calls for assistance?	1	2	3	4	5	6	7	8	9	10
13. Are residents and family involved in resident care planning?	1	2	3	4	5	6	7	8	9	10
14. Does the home offer appropriate therapies (physical, speech, etc.)?	1	2	3	4	5	6	7	8	9	10
15. Does the nursing home have an arrangement with a nearby hospital?	1	2	3	4	5	6	7	8	9	10

Part 4 - Safety
16. Are there enough staff to appropriately provide care to residents?	1	2	3	4	5	6	7	8	9	10
17. Are there handrails in the hallways and grab bars in bathrooms?	1	2	3	4	5	6	7	8	9	10
18. Is the inside of the home in good repair and exits clearly marked?	1	2	3	4	5	6	7	8	9	10
19. Are spills and other accidents cleaned up quickly?	1	2	3	4	5	6	7	8	9	10
20. Are the hallways free of clutter and well-lighted?	1	2	3	4	5	6	7	8	9	10

Part 5 - Other Concerns
21. Does the home have outdoor areas (patios, etc.) for resident use?	1	2	3	4	5	6	7	8	9	10
22. Does the home provide an updated list of references?	1	2	3	4	5	6	7	8	9	10
23. Are the latest survey reports and lists or resident rights posted?	1	2	3	4	5	6	7	8	9	10
24. (Your Concern)	1	2	3	4	5	6	7	8	9	10
25. (Your Concern)	1	2	3	4	5	6	7	8	9	10

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.