Why This Checklist Is Different
- •Every question includes the data benchmark. Don't just ask "Is staffing good?" Ask "What are your RN hours?" and know that 0.75+ is the 5-star average.
- •Based on analysis of 14,751 facilities. We know what good looks like because we've seen the numbers.
- •Printable and actionable. Bring this on your tour. Check boxes. Take notes. Compare facilities.
- •Focused on what matters. Not the lobby chandelier. The staffing ratios, safety records, and care practices.
Before You Tour: Do Your Homework (15 Minutes That Matter)
Tours are curated experiences. They'll show you the nice lobby and one smiling resident. Data shows you what happens when you're not there.
Step 1: Check the Inspection Report
Go to Medicare.gov/Care Compare and search the facility name.
Look for:
- Any immediate jeopardy violations (J, K, or L severity codes)? Walk away.
- Patterns—same violations appearing on multiple inspections
- How fast they corrected issues (correction dates)
- Total number of deficiencies vs other facilities in your area
Step 2: Look Up Their Metrics on WiseCareGuide
Use our facility search to check:
- Star rating (overall + health inspection + staffing + quality measures)
- RN hours per resident per day
- Total nursing hours per resident per day
- Nurse turnover rate
- Deficiency history and severity
Step 3: Know the Benchmarks
When you ask "What are your RN hours?" you need to know if their answer is good or terrible.
How to Tour: Timing & Strategy
When to Visit
Best Times
- Morning (7-9am): Breakfast, morning care routines
- Lunch (12-1pm): Meal service, dining assistance
- Evening (5-7pm): Shift change, dinner
- Weekend: Lower staffing (this is when problems show)
Avoid Only Touring
- Scheduled 2pm appointments (they've prepared)
- Middle of afternoon (quietest time)
- Only visiting once
- Only seeing areas they choose to show
What to Bring
- This checklist (printed)
- Notebook for observations and answers
- Camera (ask permission first)
- List of your loved one's specific needs
- Questions about specialized care (dementia, Parkinson's, etc.)
The 25 Questions (Organized by Category)
Each question includes what to ask, why it matters, what to look for, and the data benchmark.
Category 1: Staffing (The #1 Quality Predictor)
Questions 1-5
"What are your current RN hours per resident per day?"
RN hours are the strongest predictor of quality care. Registered nurses provide skilled medical care, oversee CNAs, and catch problems early.
5-star facilities average 0.77 RN hours. 1-star facilities average 0.51 RN hours. That's 51% more skilled nursing care at top-tier facilities.
- "We meet state requirements" (vague dodge)
- "We have nurses on duty 24/7" (doesn't tell you HOW MANY)
- Won't give you a specific number
"What are your total nurse staffing hours per resident per day?"
Shows overall nursing coverage (RNs + LPNs + CNAs combined). More hands = better care.
CMS tracks this metric. National average is around 4.0 hours. Higher is better—residents get more attention, faster response times, better outcomes.
"What is your annual nurse turnover rate?"
High turnover means staff burnout, poor management, and quality problems. Constantly training new staff instead of providing consistent care.
5-star facilities: 38.6% turnover. 1-star facilities: 53.4% turnover. High turnover means no continuity of care—staff don't know residents' routines, preferences, or baseline health.
- "I don't have that number" (they track it, they just don't want to tell you)
- "About average" (what's the actual percentage?)
- Any hesitation or evasiveness
"What is your nurse-to-resident ratio on each shift?"
Staffing varies dramatically by shift. Nights and weekends are typically lowest. This is when problems happen if staffing is inadequate.
- "How many residents does one RN cover on day shift? Evening? Night?"
- "How many residents does one CNA cover on each shift?"
Count staff badges you see. Estimate number of residents. Do the math. Does it match what they told you?
"How do you handle staffing when someone calls in sick?"
Reveals their backup plan. Call-outs happen—what matters is how they maintain care quality when they do.
- On-call staff roster
- Cross-trained employees from other units
- Reputable temp agencies they use regularly
- Mandatory overtime policy (not ideal but better than no coverage)
- "Staff picks up extra residents" (= worse care for everyone)
- "We make do"
- Hesitation or vague response
- "That rarely happens" (it happens—how do they handle it?)
Category 2: Safety & Deficiencies (What Inspectors Found)
Questions 6-10
"Can I see your most recent state inspection report?"
They're required by law to make it available. This tests their transparency and willingness to discuss problems.
- Any J-K-L (immediate jeopardy) violations? Deal-breaker.
- How many total deficiencies? (Compare to other facilities)
- Patterns—same violations repeated across multiple surveys?
- Severity codes (lots of F-G-H means actual harm occurring)
- Correction dates (how fast did they fix issues?)
- Refusal to show it immediately (they should have it ready)
- "We have a copy somewhere..." (lack of transparency)
- Defensive attitude about deficiencies
You already looked this up online during your homework. This question tests if they'll be honest with you about problems.
"Have you had any abuse or neglect violations in the past 3 years?"
Zero tolerance. Period. Even one violation is too many.
100% of 5-star facilities have no abuse violations. 26.4% of 1-star facilities have abuse violations. This is non-negotiable.
"What happened and what systemic changes did you make?" Listen for accountability vs excuses.
"What were your deficiencies on the last inspection, and how did you correct them?"
Shows accountability and transparency. Everyone gets deficiencies—what matters is how they respond.
- Specific deficiency tags (F0880, F0812, etc.)
- Clear explanation of what was wrong
- Concrete steps taken to fix it (staff training, new protocols, etc.)
- Timeline for correction
- How they're monitoring to prevent recurrence
- "Just minor things"
- "Nothing serious"
- Defensive or dismissive tone
- "The surveyor was being too strict"
"How many falls have residents had in the past 3 months?"
Falls are the #1 safety risk. Every facility tracks this—they should be able to answer immediately.
- They can answer the question (shows they track it)
- Falls with injury are tracked separately
- Average is around 2.6 falls per resident per year
- Lower is better, but zero falls is unrealistic
"What's your fall prevention protocol?" Good answers: risk assessments, interventions (bed alarms, non-slip socks, hip protectors), staff training, environmental modifications.
"How many pressure ulcers (bedsores) have developed here in the past year?"
Pressure ulcers indicate neglect—not repositioning immobile residents frequently enough. This is a CMS quality measure.
This data is on Medicare.gov Care Compare under quality measures. Look up "Percentage of long-stay residents with pressure ulcers."
Category 3: Care Quality & Practices
Questions 11-17
"Walk me through a typical day for a resident with my loved one's needs."
Reveals their individualized care approach vs one-size-fits-all routines.
- Specific daily schedule tailored to needs
- Personalization ("We'd assess their preferences...")
- Activities matched to abilities
- Flexibility vs rigid routines
- How they accommodate individual sleep/wake preferences
Generic answer that could apply to anyone. "All our residents get breakfast at 7:30, activities at 10..." Residents are individuals, not widgets.
"How do you handle residents with dementia or behavioral issues?"
Shows training and care philosophy.
Good answers: Person-centered approach, redirection techniques, specialized training. Bad: Heavy reliance on medication.
"What is your policy on restraints?"
Restraints should be last resort, not convenience.
Look for: "Rarely used, only MD prescribed." Red flag: Casual use or residents restrained during your tour.
"How often do residents get bathed/showered?"
Basic hygiene reveals staffing adequacy.
Minimum: 2-3 times per week. Red flag: "Once a week" or "as needed." (Data: 16.1% of citations involve quality of life issues including hygiene)
"Can I see a sample care plan?"
Care plans show individualized approach.
Look for: Specific goals, interventions, timelines, regular updates. Avoid: Generic templates. (Data: 17.5% of citations are care planning failures - F0656)
"How do you involve family in care decisions?"
Shows communication and partnership.
Good answers: Regular care conferences, family can call anytime, updates on condition changes, input welcomed.
"What is your infection control protocol?"
F0880 is the #1 most cited deficiency (12.4%).
Observe: Hand hygiene stations, staff washing hands between residents, isolation protocols discussed, PPE available.
Category 4: Activities & Quality of Life
Questions 18-20
"What activities do you offer, and how often?"
Look for: Daily activities (not just weekly), variety, individual + group options, posted calendar. Red flag: Empty activity room.
"Can residents personalize rooms with belongings?"
Observe: Do rooms look individualized or institutional? Dignity matters.
"Are there outdoor spaces residents can access?"
Look for: Secure, accessible areas, actually used (not just decorative).
Category 5: Food & Nutrition
Questions 21-22
"Can I see this week's menu and try a meal?"
Visit during mealtime. Watch residents eat. Are they getting help when needed? Food temperature OK? Residents actually eating it?
Data: 17.4% of citations involve nutrition/dietary. F0812 (food safety) is #2 most common tag.
"How do you monitor residents' weight and nutrition?"
Look for: Monthly weight checks minimum, interventions for weight loss >5%, dietitian involvement, supplements offered.
Category 6: Medical Care
Questions 23-24
"Is there a doctor on-site? How often?"
Good: Medical director visits regularly, on-call physician 24/7, quick access for residents.
"How do you handle medical emergencies?"
Good: Staff CPR/first aid trained, clear protocols, nearby hospital relationship. Bad: Vague "we call 911."
Category 7: The Money Question
Question 25
"What is the total monthly cost, and what's included vs extra?"
Advertised price ≠ actual bill. Get the full picture.
- Base monthly rate for semi-private vs private room
- What services are included in that rate?
- Common add-ons (therapy, beauty salon, laundry, cable TV)
- Level-of-care increases (do they bump you to higher tier as needs increase?)
- Upfront fees (community fee, deposits, furniture rental)
"Can I see a sample invoice from an actual resident?" (anonymized). Also ask: "How much should I expect the bill to increase in the first year?"
During Your Tour: What to Observe (While They're Talking)
Use your eyes. What you see tells you more than what they say.
Environment Checklist
Staff & Residents
🚩 Deal-Breaker Red Flags
After the Tour: How to Evaluate
Compare what they told you to what the data shows. Verify everything.
Must-Haves (Deal-Breakers If Missing)
Strong Preferences
Verify with Data
Use WiseCareGuide to verify the numbers they gave you. Check if their verbal answers match written reports. Compare staffing, turnover, and deficiency data to benchmarks.
Trust Your Gut (But Verify with Data)
The Feeling Test
- • Would you want to live here?
- • Did staff seem genuinely caring?
- • Were residents treated with dignity?
- • Did it feel like a home or a hospital?
- • Can you picture your loved one here?
But Check the Data
- • Their staffing numbers vs benchmarks
- • Inspection reports vs what you saw
- • Deficiency patterns over time
- • Compare to other facilities in area
- • Quality measures (falls, pressure ulcers)
The Best Facility =
Good feeling + Strong data
If the facility feels right but the data is weak, keep looking. If the data is strong but something feels off, trust that instinct and dig deeper.
Compare Facilities Using Real Data
Use our facility comparison tool to see staffing levels, deficiency histories, and quality measures side-by-side. Filter by your priorities and find facilities that meet the benchmarks.
Ready to Tour Facilities?
Use this checklist when visiting nursing homes in your area:
Methodology
Staffing benchmarks and quality metrics are based on analysis of 14,751 Medicare-certified nursing homes from CMS Provider Information and quality measure datasets.
Deficiency citation percentages come from analysis of 411,456 government deficiency citations over the past 3 years.
Benchmarks represent averages for 5-star vs 1-star facilities. Data current as of January 2025.
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