Most families are given 24 to 48 hours to choose a nursing home. A hospital discharge planner hands you a list, you tour one or two facilities, and you make a decision that will cost your family $250,000 or more and directly affect someone you love.
The facilities you visit are prepared for your tour. They know what to show you. Here are the questions that get past the tour script — questions rooted in what the government's own inspection data actually predicts about care quality.
1. What is your CMS Five-Star overall rating, and what is your health inspection rating specifically?
The overall rating can mask a weak inspection score. A facility can have a 3-star overall rating because it scores well on staffing and quality measures, but has only 1 star for health inspections — meaning inspectors found serious problems. Ask for all four component scores: overall, health inspections, staffing, and quality measures.
You can verify this independently at NursingHomeUSA or directly at CMS Care Compare. If the facility's stated rating doesn't match what you find, that's itself a red flag.
2. Do you have any active abuse or neglect citations from CMS?
This question will make a good facility proud to say no. It will make a problematic facility uncomfortable. CMS flags facilities with an active abuse citation directly in its public data — meaning inspectors found evidence of resident abuse during a recent inspection that hasn't been corrected.
You can check this before you visit. Any facility with an active abuse citation on NursingHomeUSA has a red banner at the top of its profile. Don't take the facility's word for it — verify independently.
3. What is your RN staffing ratio — how many registered nurse hours per resident per day?
This is the single most researched predictor of care quality in nursing home literature. CMS recommends a minimum of 0.5 RN hours per resident per day. Facilities below this threshold have consistently worse outcomes across fall rates, pressure ulcer rates, and hospitalization rates.
Ask specifically about registered nurses (RNs), not total nursing staff. A facility may have adequate total staffing but very few actual RNs — with the gap filled by CNAs who have far less training.
4. What is your nurse turnover rate over the past 12 months?
High turnover is a compounding problem. When nurses leave frequently, residents are regularly cared for by unfamiliar staff. New staff make more errors. Institutional knowledge about individual residents' needs is lost. CMS tracks and publishes RN turnover rates — any facility over 40% warrants scrutiny, and over 60% is a serious concern.
If the admissions coordinator doesn't know this number off the top of their head, that tells you something about how closely management tracks it.
5. Are you on the CMS Special Focus Facility list?
The Special Focus Facility (SFF) program identifies nursing homes with a pattern of serious deficiencies over multiple inspection cycles. These are, by CMS's own designation, the worst-performing nursing homes in the country. Being on this list means repeated serious problems — not a one-time error.
Some facilities on the SFF list are working to improve. Others have been on it for years. You can check any facility's SFF status on NursingHomeUSA.
6. How many total deficiency citations did you receive in your last three standard inspections?
CMS inspects every nursing home at least annually. Every deficiency found is a citation. The number of citations matters, but so does the severity. Ask specifically about any citations at severity level G or higher — those are citations where a resident was actually harmed, not just at risk.
Request to see the actual inspection report. Facilities are required to post their most recent inspection report in a public area. You can also download the full text of inspection reports from CMS.
7. What is your current occupancy rate, and do you have a waiting list?
High-quality facilities often have waiting lists. A facility with many empty beds may be struggling financially, which affects staffing and care quality. This isn't a definitive measure — some good facilities have capacity — but it's a useful data point.
It also matters for your situation: if you need a bed immediately, you need to know real-time availability. Ask about actual available beds today, not beds they expect to have available.
8. What happens when a resident needs hospitalization — how do you handle the transition?
Hospital readmission rates are a quality measure CMS tracks and publishes. Facilities with high readmission rates may be failing to catch deteriorating conditions early, or may be sending residents to hospitals for problems that could be managed in-facility.
Ask: "In the last year, how many residents were hospitalized, and how many were readmitted within 30 days of returning?" Good facilities track this. Facilities that don't track it can't manage it.
9. What is your policy if a resident has a complaint or concern about care?
Listen carefully to how this is answered. A good facility will describe a clear, resident-centered process. A problematic one will be vague, emphasize the "great relationships" with families, or pivot to talking about how happy residents are.
Federal law requires every nursing home to have a grievance process, a Resident Council, and to post the contact information for the Long-Term Care Ombudsman program. Ask to see where the Ombudsman contact information is posted.
10. What does CMS's data say about your rates of pressure ulcers, falls, and antipsychotic medication use?
These are among the most meaningful quality measures in the CMS dataset:
- Pressure ulcers (bed sores) indicate residents aren't being repositioned regularly — a basic care function
- Falls indicate whether the physical environment and supervision are adequate
- Antipsychotic medication rates are a proxy for whether residents with dementia are being chemically restrained rather than properly cared for — a serious and common problem
All three are published by CMS and visible on Care Compare and NursingHomeUSA. A facility that ranks poorly on all three in your state deserves a hard conversation before you commit.
One More Thing: Verify Everything Independently
The single most important thing you can do before choosing a nursing home is to check the CMS data yourself — not rely on what the facility tells you, not rely on a referral service that takes money from those same facilities.
NursingHomeUSA shows you the same government data, for all 15,800 facilities, with no financial relationship with any of them. Browse by state and find the facility you're considering — the abuse alerts, staffing hours, inspection citations, and star ratings are all there.