21 Questions to Ask a Nursing Home Before You Sign Anything

Twenty-one questions, grouped by what they actually protect: your parent's body, your parent's money, and your own legal footing. Ask them before you sign. The answers to some of them are public record, which means you can verify rather than trust. Start with those, and treat everything else as a conversation the admissions director has had a hundred times and knows how to steer.

One framing note before the list. You are not interviewing a hotel. You are deciding whether to hand over the daily care of someone who cannot check the work themselves. That asymmetry is why the questions below lean hard on staffing, incidents, and the contract, and why "the tour was lovely" is not evidence of anything.

Why 21 questions and not three

Most families ask three things: is there a bed, what does it cost, and does Medicare pay. Those three questions get answered cheerfully and tell you almost nothing. A facility can have a bed, quote a rate, and accept Medicare, and still be one of the roughly 526 facilities that are in or being considered for the CMS Special Focus Facility programme, the federal list for homes with a persistent pattern of poor care.

If you want a shortlist before you ever walk in, run the names through our nursing home search first. We cover 14,696 Medicare-certified homes, and 14,651 of them carry a letter grade. Walking in already knowing what the last inspection found changes the entire conversation, because the person across the table knows you know.

The 21 questions split into five buckets: staffing, care, money, the public record, and the contract. The last bucket is the one that costs families the most, because it is the one nobody reads.

Staffing questions (the ones that predict everything else)

Staffing is the closest thing this industry has to a master variable. Not the only one, but the one that shows up first when things go wrong. The national average for total nurse staffing is 3.86 hours per resident per day, and registered nurse staffing averages 0.69 hours. Those are averages, which means half the country sits below them.

1. What is the nurse-to-resident ratio on the day shift, the evening shift, and overnight?

Ask for all three, separately. Day shift is always the best-staffed and is the shift you will see on your tour. Overnight is where the risk concentrates. National weekend nurse staffing averages 3.42 hours per resident per day, below the overall average, so weekends are a real question rather than a hypothetical one.

2. Is there a registered nurse physically in the building overnight, or on call?

This is a different question from "do you have RN coverage." A nurse on call from home is not in the building. Get the specific answer for the hours between, say, 11pm and 6am.

3. How many shifts a week are covered by agency or contract staff?

Agency staff are not automatically worse caregivers. The problem is continuity: your mother may see a different face every night for two weeks, and nobody accumulates the pattern knowledge that catches a UTI early or notices a new swallow problem. Ask what share of shifts, and whether it has been rising or falling.

4. What is your nursing turnover rate?

The national average is 46%. That number is startling on its own, and it means a home with a turnover rate around 46% is not an outlier, it is typical. A home that cannot tell you its rate either does not track it or does not want to say. Both are answers.

5. How many certified nursing assistants are on the floor at 3am for how many residents?

This is the question that separates homes. The 3am ratio is where call lights go unanswered and where a fall in the bathroom stays undiscovered. If the answer is vague, ask it again with the specific hour.

If staffing numbers are new to you, our guide on what staffing numbers actually mean explains how to read them off a facility's federal profile before you ask anyone anything.

Care questions (how the place behaves when you are not there)

Staffing is capacity. Care planning is what the capacity is pointed at. These questions are about process, and process is where you find out whether the home is organized or just busy.

6. Who writes the care plan, and who signs off on it?

You want to hear that the plan is built from an assessment, reviewed with the resident and family, and revised when something changes. If the answer is "the nurse does it," ask which nurse and when it gets updated.

7. How often is the care plan formally reviewed, and what triggers an out-of-cycle review?

A change in condition should trigger one. So should a fall, a hospital stay, a new medication, or a noticeable decline in eating or mobility. Ask what the trigger list is.

8. Who do I call at 10pm if something is wrong, and will that person actually answer?

Get a name and a number. Not "the front desk." A specific role, and confirmation that the role is staffed overnight.

9. How and when are families told about a fall or an incident?

Same day, next day, or at the next care conference? Any of those might be the policy, but you want to know which one, because you will be measuring against it later. Ask whether notification is by phone or only in person.

10. What is your process when a resident's condition changes and the family disagrees with the plan?

This is a real scenario, not a trap. You want to hear that there is a named person who handles it and a process that does not depend on catching the right nurse in the hallway.

Say, for illustration, a resident is admitted after a hip fracture, initially for skilled rehab. Six weeks in, the therapy minutes drop, the resident is sleeping through meals, and the family thinks the plan has quietly shifted from rehab to long-term custody. That is the moment questions 6, 7 and 10 stop being theoretical. If the home cannot point to a documented review and a family conversation, the drift already happened.

Money questions (the ones with a written answer)

Rates and rules vary enormously by state and by facility, so treat any number you are quoted as a starting point you need in writing. What does not vary is that you should leave the meeting with a written schedule of charges, not a verbal one.

11. What is the daily rate for a semi-private room and for a private room?

Get both, in writing, and confirm whether the rate is the same on weekends and holidays. Some homes charge a different rate for a private room on a short-term rehab stay versus a long-term stay.

12. What is billed on top of the daily rate?

This is where the surprises live. Ask specifically about therapy, medications, supplies, laundry, transportation to appointments, and any "community fee" or admission fee. Ask for the list in writing. If the answer is "it depends," ask for the written schedule that the "it" depends on.

13. Do you accept Medicaid, and is there a bed available for a Medicaid resident today?

Two questions, not one. A facility can be Medicaid-certified and still have no Medicaid bed available. Nationally, 14,156 of the homes we cover are certified to accept Medicaid, so certification is common. Availability is not.

14. If my parent pays privately and later transitions to Medicaid, can they keep their room?

This is the single most consequential money question for families planning ahead, and the answer is not uniform. Some homes guarantee the room. Some move the resident to a different bed or a different unit. Some have no written policy at all. Get the answer in writing before you sign, because once you are in, your leverage is gone.

15. Is private pay required for a set period before Medicaid is accepted?

Some homes require a period of private pay before they will accept a Medicaid conversion. Ask directly whether that applies here, and how long it is. Do not accept a verbal estimate.

For the payer rules underneath these questions, our guide on who pays for nursing home care walks through the Medicare, Medicaid and private pay sequence. Costs by state are in what care costs, and Medicaid rules by state are in Medicaid by state.

The public record questions (ask before you tour)

Everything in this section is already public. You are not asking the home for a favor. You are confirming that what they tell you matches what the federal government has already recorded.

16. What did your last health inspection find?

Ask for the citation list, not the summary. Our database holds 419,479 health inspection citations across the facilities we cover, and 22,914 of them were scored at actual harm or immediate jeopardy, which is scope and severity G or above. A home that cannot tell you what it was cited for last time is not tracking its own record.

17. What has changed since that inspection?

The citation matters less than the response. New director of nursing? Different staffing model? Retrained unit? If nothing changed, expect the same findings next cycle.

18. Are you on any CMS special focus list, or a candidate for one?

There are 526 facilities in or being considered for the Special Focus Facility programme. There are also 1,428 facilities currently carrying a CMS abuse icon. Both are searchable. Ask the question anyway, and watch how it is answered. The reaction tells you as much as the fact.

19. Who owns this building, and how many other homes do they operate?

Ownership matters because staffing and capital decisions are made above the administrator's head. Our ownership tracker holds 248,794 records from the CMS ownership file, and 10,119 facilities belong to a named chain. A home owned by a large chain is not automatically worse, but the chain's record across its other buildings is fair evidence about how it runs things.

You can check all of this yourself before the meeting. The watchlist of flagged homes is the fastest place to confirm whether a name you are considering already has federal attention, and our guide on how to read an inspection report will let you read the actual citations rather than the facility's summary of them.

Contract questions (the ones with legal consequences)

The admissions packet is long, it arrives at a stressful moment, and it is designed to be signed. Read it anyway, or have someone read it for you. Two clauses deserve specific attention.

20. Does this contract include an arbitration clause?

Arbitration clauses in nursing home admission agreements are common. They typically require disputes to be resolved through a private arbitrator rather than in court, and they can limit discovery and the availability of certain remedies. Ask whether the agreement contains one, and ask for the specific section.

21. Can I decline the arbitration clause, and will declining affect admission?

In most circumstances, agreeing to arbitration is not a condition of admission, and the clause can be refused. Ask the home to confirm in writing that declining the clause will not affect admission or care. If they will not put that in writing, that is information you should weigh. Some families also ask whether the clause can be signed separately from the rest of the agreement, so the refusal is documented. This is a legal question with state-by-state variation, so if the amounts or the stakes are significant, run the contract past a lawyer who works in your state.

Our guide on residents' rights covers the federal protections that apply regardless of what the contract says.

How to ask without burning the relationship

You can ask all 21 questions and still be seen as a reasonable family, or you can ask three and be seen as difficult, depending entirely on how you frame it. The framing that works: you are not testing them, you are preparing to be a useful partner.

Two practical moves. First, ask for the written materials before the meeting, so the conversation is about the gaps rather than a recitation of things you could have read. Second, bring a second person. One of you asks, one of you writes. Memory for this kind of conversation is unreliable, and the details that matter (the overnight ratio, the Medicaid bed policy, the arbitration clause) are exactly the details that get smoothed over in recollection.

If an answer is "we don't give out that information," treat it as a complete answer to the question and factor it in.

The mistake almost everyone makes on this topic

The common mistake is not asking bad questions. It is asking good questions to the wrong person, at the wrong moment, and accepting verbal answers.

Here is what that costs. Say a family tours three homes, likes the second one, and asks the admissions director about Medicaid. The director says, "Oh yes, we take Medicaid, and residents don't have to move." The family signs. Fourteen months later, private funds run out, the Medicaid application goes in, and the business office explains that the facility's Medicaid-certified beds are on a different unit, and the resident will be moved. The family has nothing in writing. The bed they were promised does not exist, and the parent, who is now more impaired than at admission, has to relocate.

The fix is mechanical, not emotional. Ask for the Medicaid bed policy in writing. Ask for the arbitration clause to be identified by section number. Ask for the rate schedule as an attachment. If the person you are talking to cannot produce those documents, ask who can, and schedule a second meeting with that person. The second meeting is where the real answers come from.

The other half of the mistake is not checking the public record at all, and relying on the tour. A tour shows you the lobby, the activity room, and a resident who was selected for you to meet. It does not show you the 3am staffing sheet or the citation history. Both are available before you go. If you want to compare two homes against each other on the same measures, the side-by-side comparison tool will do it in one screen.

What to do if the answers contradict the record

Occasionally the home's answer and the federal data diverge. The staffing number quoted does not match the reported number. The inspection summary omits a citation that is plainly in the file. This is not always deception; administrators change, and internal knowledge decays. But it changes what you do next.

If a staffing figure does not match, ask for the source of their number and compare it to the federal staffing data. If a citation was omitted, ask specifically about it by name. How the home handles being caught in a gap is the most useful information you will get in the entire process. A home that says "let me pull the file and get back to you tomorrow" is behaving normally. A home that gets defensive about a public document is telling you something about how it will handle your parent's fall report.

You can also use our grading methodology to understand exactly which federal measures go into a letter grade and which do not, so you know what you are and are not looking at. If you want to see what a strong record looks like by comparison, the best-graded homes list is a useful calibration before you tour anything.

Questions to ask after admission, not just before

The 21 questions do not retire once the contract is signed. Several of them should be re-asked at the first care conference and every one after that, because the answers change.

• Has the staffing ratio on my parent's unit changed since admission, and in which direction?
• Has my parent had any falls or incidents since the last conference, and was I notified at the time?
• Has the care plan been revised, and what triggered the revision?
• Has anything about the payer status changed, and does that affect the room?
• Has the facility received any new citations since admission?

Ask these on a schedule, not only when something goes wrong. Families who ask regularly get better information than families who ask once, in a crisis, when the answers are already shaped by the situation.

A short version, if you only have ten minutes

If you cannot run the full list, run these five, and get the answers in writing.

1. Who is in the building at 3am, and how many residents are they responsible for?
2. What is your nursing turnover rate?
3. If my parent transitions to Medicaid, do they keep this room?
4. What did your last inspection find, and what changed afterward?
5. Does this contract contain an arbitration clause, and can I decline it without affecting admission?

Those five cover staffing, continuity, the money cliff, the public record, and your legal footing. Everything else is detail on top of them.

The bottom line

Ask the 21 questions, but understand that the answers that matter most are the written ones: the Medicaid bed policy, the rate schedule, the arbitration clause, and the inspection history. Verbal assurances at a tour are worth very little, and the federal record is available to you before you ever walk in, so use it. If a home will not put its Medicaid bed policy or its arbitration terms in writing, that reluctance is itself the answer, and you should keep looking.

Where these figures come from

Every number in this article that describes American nursing homes comes from the CMS Provider Data Catalog, the same public federal files behind Medicare's Care Compare. You can see exactly which datasets we use, and how current they are, on our data sources page. Nothing here is medical, legal or financial advice, rules differ by state and change over time, so verify anything that affects a decision with the facility, your state survey agency, your Long-Term Care Ombudsman, or a qualified professional.