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This easy-to-use website features basic health and wellness information for older adults from the National Institutes of Health.





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Evaluating Care Facilities




Caregiver Note: If a loved one has been hospitalized and it is determined that the individual needs to be moved to a care facility and you have not had time to evaluate nursing facilities you can appeal to Medicare to extend the individuals hospital stay for up to two days. This will allow you some additional time to evaluate and find a quality living facility. If you determine that you need to do this tell the nurse that you would like to speak to your loved one's social worker or care coordinator. They will be able to assist you through this process.


Locating Care Facilities & Finding Assistance

Before beginning the evaluation process be sure that you have a clear understanding of the individuals physical limitations and what services are needed. If you are unsure of what services might be needed talk with your loved one's primary care physician. Knowing this information will assist you in determining the level of care required.


To obtain a list of the living facilities in your desired area you can contact the Oklahoma Area Agency on Aging. You can find this information online by going to the U.S. Administration on Aging Eldercare Locator. You can search by ZIP code or by city and state. You can also call them at 1-800-677-1116.


Oklahoma's Long-Term Care Ombudsman can provide at no-charge assistance as well. The ombudsman addresses concerns about care and service within long-term living facilities. The ombudsman ensures that the residents rights are protected and that regulations are enforced to ensure the safety of those living in long-term facilities. The ombudsman investigates complaints and is familiar with long-term living facilities through the state of Oklahoma. You can locate your area ombudsman through the Eldercare Locator. or by contacting the Oklahoma Department of Human Services Senior Info-line at 1-800-211-2116.

Whole Person Wellness


An area that is often overlooked and discussed little is the area of evaluating living facilities for whole person wellness. When visiting a living facility ask questions that will help you determine how well the residents physical, social, emotional, and spiritual needs will be addressed. Some good questions to ask to determine how spiritual needs will be addressed include asking if the facility has a Chaplain on staff. If so, how often does the Chaplain visit residents? If no Chaplain is staffed then ask how patient's spiritual needs are currently being addressed. Other questions to ask include:

  • Are worship services provided?
  • Does the facility have a Chapel?
  • If not, where are services held?
  • Who conducts the services? Is it the Chaplain or volunteers from a local church for example.

Consider the potential residents religious beliefs, practices and tradition. How well will the facility address and service these needs? If worship services aren't provided what other opportunities exist for the resident to express their spirituality such as prayer groups, discussion groups and gatherings to sing hymns. If a Chapel doesn't exist where can residents go for quiet contemplation and meditation. Everyone can benefit from spiritual nurture regardless of their medical condition. Even residents with Alzheimer, dementia or head trauma find comfort and/or benefit in spiritual wellness.


Financial Considerations


Important consideration needs to be given to the financial aspects of moving into a living facility. Many individuals may not be able to pay for the full term of their stay in a particular facility. Medicare and Medicaid only pay for care within certain facilities. For example, Medicare/Medicaid does not pay for an individual to live in an Independent Living Facility, Residential Care Facility, or Assisted Living Facility. Some Medicare/Medicaid assistance may be available for other types of facilities based on the individual's medical condition. It's recommended that you talk with the individuals doctor, care coordinator, or social worker to determine Medicare/Medicaid eligibility for living facility care.


If Medicare/Medicaid is not an option some things to ask and consider include:

  • Does the living facility require some type of prepayment?
  • Is any portion of the prepayment refunded should the resident decide to leave the facility?
  • What services are included and what services cost extra? For example, some facilities have a physician on staff, others contract out and charge a fee for services rendered. While the resident has the right to see their own physician they may have to pay extra for this service if staff physician services are provided as part of the facilities care package.



Before making a financial investment to live in a retirement community take some time to research the facilities fiscal soundness. While this may sound overwhelming it really doesn't have to be. Here are some steps that can assist you in determining if a facility is fiscally sound.

  1. Ask the facility you are evaluating for an audited financial statement. If the facility doesn't want or refuses to provide the information you should consider this a potential indicator of financial instability.
  2. Ask what the occupancy ratio for the facility is? If the facility has a low occupancy ratio you might want to consider this a sign of potential financial instability though other factors may play into the low ratio.
  3. Investing in a Continuing Care Retirement Community is a costly venture, it's recommended that you have a financial expert review the financial statements of any facility you are considering investing into.



The Commission on the Accreditation of Rehabilitation Facilities (CARF) has a free "Consumer Guide to Understanding Financial Performance and Reporting in CCRC's". This guide discusses such topics as Entrace Fee Structure, Monthly Fees, CCRC Contract Types, Financial Performance Indicators, Questions to Ask, and etc.


A second source for information is the American Association of Homes and Services for the Aging. They also offer a free guidebook titled "The Continuing Care Retirement Community: A Guidebook for Consumers". Some information covered in this guide include resident service agreements, entrance fees and refunds, accommodations and services, operation stress points, and etc.

Checklists and Monitoring Resources


There are a lot of things to look at and consider when evaluating a care facility. A good recommendation is to utilize a checklist so that you can easily be reminded of what to ask and look for. A Nursing Home Checklist is available through Medicare. Medicare also has a Nursing Home Compare feature which provides overview information to help in evaluating living facilities, primarily Medicare and Medicaid certified facilities. You can also call 1-800-MEDICARE (1-800-633-4227) and request information and a checklist.


The Consumer Reports Nursing Quality Monitor if a free web based service. This monitor identifies nursing facilities that they determine are likely to provide better quality care. The site also lists those facilities they feel should be avoided. Three dimensions of quality were used to determine the living facilities ranking; deficiencies, staffing levels, and quality indicators.



Visiting the Care Facility


Once you have narrowed your search to two or three facilities it's recommended that you visit those facilities. It's recommended that at least two visits be made; one scheduled and one unscheduled. This is also a good time to bring a Nursing Home Checklist so that you can more easily compare facilities at a later date. If the individual who is to reside in the facility is able they should be included in visiting the facilities.


While you are visiting take time to notice your surroundings:

    Notice the cleanliness and odors of the facility.

  • Is the facility homey and inviting?
  • Is there good lighting?

    • Observe how the residents are dressed and groomed.

  • Are their cloths appropriate for the time of year.

    • Listen to how the staff is talking to the residents.

  • Is their tone of voice pleasant or short tempered?

    • Checkout the monthly activity schedule.

  • What stimulation activities are offered to the residents living there?

    • Try to visit during meal time.

  • Does the food look appealing?
  • Ask if you might taste the food if you have concerns.

    • Pay attention to those individuals who are not eating.

  • Are they being assisted or ignored?

    • Evaluate the staff and contract agreement.

  • Ask to meet the administrator.
  • How are staff screened and trained and how often does this occur?
  • What is the staff turnover rate?
  • What is the ratio of staff to residents?
  • Ask for a copy of the admissions contract and review it carefully.

    • Visit with some of the current residents and their family members.

  • Ask how they like living there?
  • Do they like the staff?
  • Do they like the available activities?
  • Do they like the food?



An unannounced visit on a weekend or during evening hours might prove very helpful in making your decision. Be sure to check in at the main desk or nurse's station when you arrive. Explain that you are considering their facility and you would like to take some time to observe residents and staff. If you feel that you are unwelcome or if you are asked to leave you might want to consider this a negative aspect in the visitation process. In some cases you might be able to arrange an overnight stay for your loved one before making a final decision.

A Note About Evaluating Hospice Care


When you enter into Hospice Care you are entering into a program of care rather than a place. Hospice is a coordinated program of care carried out in the home or some other living facility. The hospice team consists of nurses, social workers, home health aides, trained volunteers, chaplains and speech, physical and occupational therapists if needed. All these individuals work in consultation with the patients personal physician and/or the hospice medical director or physician.


A hospice can function as either “for-profit” or “nonprofit” and shouldn’t make a difference in the quality of care you receive, though this might not always be the case. For-profit hospices are organized for the purpose of making money and paying dividends to stockholders. Nonprofit hospices are organized for the purpose of fulling a nonprofit mission. Any hospice you consider should be state licensed, and certified by Medicare. Some hospices will also be accredited through organizations such as The Joint Commission. You might also find some that are members of a hospice and palliative care association.


It’s important to recognize that there are good and bad “nonprofit” hospice programs just as there are good and bad “for-profit” hospice programs. Effective evaluation is necessary to ensure quality care is provided. The more knowledgeable you are about the services you are entitled to receive the better you will be able to advocate and make decisions that will ensure your loved one’s and the families needs are met.