Choosing a nursing home is a decision many families make under pressure, often from a hospital hallway with a discharge planner waiting for an answer. That said, one well-prepared tour can bring most of what matters to the surface — as long as you know which questions to ask and which documents to request.
The questions below are grouped by category so you can bring them on tour day and check them off as you go. They cover staffing, care planning, the admission agreement, and the switch from private pay to Medicaid, which many printed checklists leave out.
Bring four groups of questions to a nursing home tour: staffing and turnover, care-plan meetings, admission-agreement clauses, and Medicaid conversion. Ask for written answers and the latest inspection report.
Before The Tour: What To Pull Up First
A tour goes better when you arrive with the facility's public record in hand. Medicare.gov Care Compare posts star ratings, inspection results, staffing hours per resident day, weekend staffing, and nurse and administrator turnover for every Medicare- and Medicaid-certified nursing home.
Keep in mind that the staffing figures come from Payroll-Based Journal data the facility submits to CMS, so they reflect paid hours rather than marketing claims. Here is what to gather before you go:
- Care Compare profile. Note the overall, health inspection, staffing, and quality-measure ratings, and print the staffing page so you can refer to it during the visit.
- Most recent inspection report. Federal resident-rights rules at 42 CFR 483.10 require facilities to make their most recent survey results available to read, usually in a binder near the entrance.
- Blank admission agreement. Ask the admissions office to email the full agreement and every addendum ahead of time so you can read it at home rather than at a signing table.
- Long-term care ombudsman contact. Every state runs a long-term care ombudsman program under the Older Americans Act, and the local ombudsman can often describe complaint patterns at a given facility.
All of this takes about an hour, and it turns the tour from a sales visit into a chance to check what you have read. For a broader way to compare facilities, see our guide to choosing a nursing home.
Staffing And Turnover Questions
Staffing largely decides the quality of care, because aides provide most of the hands-on help with bathing, eating, toileting, and repositioning. Federal rules at 42 CFR 483.35 require sufficient nursing staff, a registered nurse on site at least eight consecutive hours a day, seven days a week, and a full-time director of nursing.
CMS finalized a numeric minimum-staffing rule in 2024, but a federal court vacated it in 2025 and Congress later delayed its enforcement. As a result, check the current federal status before relying on any specific ratio, and find out whether your state sets its own minimum hours.
Ask how many residents each aide covers on day, evening, and night shifts, and how often agency staff fill gaps. Compare the answer to the facility's Care Compare staffing and turnover figures.
Here are the staffing questions to put to the administrator or director of nursing:
- Aide-to-resident ratio by shift. Ask for the numbers on the unit your parent would live on rather than a building average. Ask about nights and weekends specifically.
- Licensed nurse coverage. Ask how many LPNs and RNs work each shift and whether an RN is in the building overnight.
- Turnover. Ask what nursing turnover was over the last 12 months and how long the director of nursing and the administrator have held their roles.
- Agency staffing. Ask what share of shifts temporary agency staff cover, since agency workers may not know residents' routines, preferences, or warning signs.
- Consistent assignment. Ask whether the same aides care for the same residents from day to day. Familiar staff tend to notice changes in appetite, mood, or mobility sooner.
- Call-light response. Ask how response times are tracked, what the target is, and who reviews the results.
Remember that the answer matters less than whether it matches the public data. If the administrator describes staffing that looks very different from the Care Compare figures, ask them to explain the gap.
The floor itself tells part of the story, too. Notice whether call lights stay lit, whether residents are dressed and out of bed by late morning, and whether staff call residents by name.
Care-Plan And Clinical Questions
Every certified facility must build an individualized care plan, and the family's role in that process is a fair question to raise on tour. Under 42 CFR 483.21, a baseline care plan is due within 48 hours of admission, and the comprehensive care plan follows within seven days of the full resident assessment.
That full assessment — the Minimum Data Set, or MDS — is due within 14 days of admission and is repeated at least quarterly. Each review gives the family a structured meeting in which to raise concerns.
Federal rules require a baseline care plan within 48 hours of admission and a comprehensive plan within seven days of the full assessment. Ask how families are invited to care-plan meetings.
Care-planning questions to ask include but are not limited to:
- Meeting logistics. Ask how far in advance families hear about care-plan meetings and whether you can join by phone or video.
- Who attends. Ask whether nursing, social services, therapy, dietary, and activities staff all take part, and how the attending physician's input is included.
- Physician coverage. Ask how often the physician or nurse practitioner sees residents and who answers clinical questions after hours.
- Therapy. Ask whether physical, occupational, and speech therapy are provided in-house or by contract. Ask how therapy continues once Medicare coverage ends.
- Medications. Ask how the facility reviews antipsychotic and sedating medications and how families hear about changes.
- Memory care. If dementia is part of the picture, ask whether there is a secured unit and what dementia-specific training its staff receive.
- Hospital transfers. Ask which hospital the facility usually uses and how quickly families are told about a transfer.
Note that the level of care your parent needs also affects eligibility for Medicaid nursing home coverage. Our explainer on the level-of-care assessment explains how states make that determination.
Admission Agreement Questions
The admission agreement is a binding contract, and families often sign it in a rush on admission day. However, federal law sets firm limits on what a Medicare- or Medicaid-certified facility can require, and knowing those limits changes the conversation.
Ask for the full agreement and every addendum before admission day. Then read it with the following clauses in mind.
Third-Party Guarantor Language
Under 42 CFR 483.15(a)(3), a certified facility may not request or require a third-party guarantee of payment as a condition of admission, expedited admission, or continued stay. What it may do is ask someone with legal access to the resident's income or resources — such as an agent under a power of attorney — to sign and pay from the resident's funds without taking on personal liability.
Look for wording such as “responsible party,” “guarantor,” or “financially responsible” next to a family member's signature line. If the agreement suggests personal liability, ask the facility to clarify it in writing or strike it, and consider having an elder-law attorney review it.
A certified nursing home cannot require a family member to personally guarantee payment. A representative may sign to manage the resident's own funds without taking on personal liability.
Arbitration Clauses
Many agreements include a pre-dispute arbitration clause, which sends future disputes — including negligence claims — to a private arbitrator instead of a court. Federal rules at 42 CFR 483.70 bar certified facilities from requiring residents to sign one as a condition of admission or continued care.
The same rules give the resident the right to rescind an arbitration agreement within 30 calendar days of signing. Ask whether the arbitration agreement is a separate document, and keep a dated copy of anything you decline or rescind.
Other Clauses Worth Flagging
Beyond guarantor and arbitration language, several other provisions deserve a careful read. Questions to ask about the rest of the agreement include:
- Medicare and Medicaid waivers. Federal rules bar certified facilities from requiring residents to give up Medicare or Medicaid rights or to promise they will not apply. Flag any clause that reads that way.
- Bed-hold policy. Ask how many days the bed is held during a hospital stay, what holding it costs, and whether your state's Medicaid program pays for any hold days.
- Discharge terms. Ask which reasons the facility gives for discharge and how notice is delivered. Our guide to nursing home discharge rights covers the federal limits.
- Deposits and gifts. For a person eligible for Medicaid, a certified facility may not charge, solicit, or accept a gift or donation as a precondition of admission or continued stay.
- Ancillary charges. Ask for the list of items billed separately, such as personal laundry, salon services, or certain supplies.
- Rate increases. Ask how much notice the facility gives before the private daily rate changes.
Private Pay To Medicaid Conversion Questions
Many residents enter a nursing home on Medicare or private funds and later switch to Medicaid once their savings are spent down. Medicare covers up to 100 days of skilled nursing care after a qualifying three-day inpatient hospital stay, with daily coinsurance starting on day 21. On day 101, the bill shifts to private pay or Medicaid.
Medicare's skilled nursing benefit covers short-term skilled care and does not cover long-term custodial care. Our comparison of Medicaid vs. Medicare nursing home coverage explains where each program stops.
The switch to Medicaid is where many families run into surprises. It is worth asking about before admission, while other facilities are still an option.
Ask whether the bed is Medicaid-certified, whether the resident must change rooms after switching to Medicaid, and how the facility bills for months while a Medicaid application is pending.
Conversion questions to ask the business office include:
- Certified beds. Ask whether every bed is Medicaid-certified or only certain units, since some facilities certify only part of the building.
- Room changes. Ask whether a resident who switches to Medicaid must move to a different room or unit, and whether private rooms remain available under Medicaid.
- Private-pay expectations. Federal rules bar facilities from requiring an assurance that a resident will not apply for Medicaid. A clause that demands a fixed period of private pay therefore deserves close scrutiny.
- Pending applications. Ask how billing works while a Medicaid application is pending and whether the business office helps prepare the application.
- Retroactive coverage. Federal law currently allows up to three months of retroactive Medicaid coverage, though changes enacted in 2025 narrow that window for applications starting in 2027. Check the current rule with your state Medicaid agency.
- Patient liability. Ask how the resident's monthly income contribution will be collected after approval. Our explainer on the patient liability share covers how that amount is set.
- Denials and delays. Ask what happens if an application is denied or delayed, and what notice comes before any discharge for nonpayment.
Remember that the Medicaid application reviews 60 months of financial history under the five-year lookback. Uncompensated transfers in that window can create a penalty period, and our explainer on the Medicaid penalty divisor shows how states calculate it.
For families who have time before a crisis, our guide to pre-crisis Medicaid planning explains how much lead time is involved. If the home is the main asset, see what happens to the house when a parent enters a nursing home.
A Tour-Day Checklist At A Glance
The table below fits the four categories onto one printable page. Use the third column to note what to request in writing.
| Category | Core question | Ask for in writing |
|---|---|---|
| Staffing | How many residents does each aide cover by shift, including nights and weekends? | Staffing schedule for the proposed unit |
| Turnover | What were nursing and leadership turnover over the past 12 months? | Tenure of the director of nursing and administrator |
| Care planning | How do families join care-plan meetings? | Meeting notification policy |
| Guarantor | Does any signature line create personal liability? | Revised signature page |
| Arbitration | Is arbitration optional and in a separate document? | The 30-day rescission terms |
| Bed hold | How many hold days, at what cost, and who pays? | Written bed-hold policy |
| Medicaid | Is the bed certified, and does switching to Medicaid require a move? | Medicaid conversion policy |
| Pending application | How does billing work while Medicaid is pending? | Business office billing policy |
Overall, written answers matter because staff change and memories fade. A dated email from the business office carries more weight than a remark made in passing during a tour.
Red Flags To Watch For During The Visit
Some answers deserve more weight than others. Be aware of the following signals, any of which calls for a follow-up question or a second visit:
- Pressure to sign the same day. A facility that discourages taking the agreement home to read is a concern, particularly when the paperwork includes an arbitration clause.
- Vague staffing answers. “We meet all state requirements” is not a ratio, so ask for the actual numbers by shift.
- Mismatched data. Be wary of staffing or turnover claims that differ sharply from the Care Compare figures you printed.
- Unexplained inspection deficiencies. Ask what changed after any citation on the latest survey, particularly one involving actual harm to a resident.
- Unclear Medicaid answers. Be cautious if the business office cannot explain its conversion process in plain terms.
A facility that welcomes these questions is often one that expects to be held to its answers. An unannounced second visit in the evening or on a weekend can confirm what you saw on the formal tour.
When To Bring In Outside Help
Some situations can make a short legal review worthwhile, such as an agreement with guarantor or arbitration language, a pending Medicaid application, or a recent asset transfer. Elder-law attorneys review admission agreements and Medicaid applications routinely, and state long-term care ombudsmen help with resident-rights questions at no charge.
To find an elder-law attorney in your state, our elder-law attorney directory lists practitioners by location. For cost context before tour day, see our 2026 nursing home cost guide.
This article is for informational purposes and is not financial, tax, legal, or medical advice. Consult a licensed professional (CPA, elder-law attorney, state Medicaid office) before acting.